Tag: nevin manimala

Belitung Nurs J. 2021 Apr 29;7(2):78-87. doi: 10.33546/bnj.1359. eCollection 2021.

ABSTRACT

BACKGROUND: Symptom cluster management is in its early stages in many chronic and debilitating illnesses. The development of a proposed theory should be an initial step in advancing this area of interest.

OBJECTIVE: This article presents the development of a Proposed Theory of Symptom Cluster Management.

METHODS: The concept analysis, statement synthesis, and theory synthesis by Walker and Avant were used in the development of this proposed theory. A search from July to September 2020 for published empirical and theoretical articles was conducted in scientific databases, expanded on the web, and secondary references from identified articles.

RESULTS: The Proposed Theory of Symptom Cluster Management is both a descriptive and explanatory theory. The defining characteristics of symptom cluster management include the basic and effectiveness components. Antecedents for symptom cluster management include socio-demographic characteristics, symptom cluster characteristics, individual clinical characteristics, individual illness factors, and situational factors or symptom experience. The consequences are clustered as personal-related, health-related, social-related outcomes, and existential outcomes. Measurement tools for the antecedents and outcomes in symptom cluster management and the analytical and statistical strategies were considered. Relational statements were also identified. Theoretical assertions were advanced.

CONCLUSION: The Proposed Theory of Symptom Cluster Management may provide a holistic approach because it integrates both the symptom cluster and management strategies. The concepts, statements including the complete representation of the proposed theory identified in this article, may provide cues to policymakers and clinical researchers towards the development of tailored interventions and programs.

PMID:37469941 | PMC:PMC10353591 | DOI:10.33546/bnj.1359

Front Artif Intell. 2023 Jul 4;6:1060879. doi: 10.3389/frai.2023.1060879. eCollection 2023.

ABSTRACT

INTRODUCTION: The Cancer Field Effect describes an area of pre-cancerous cells that results from continued exposure to carcinogens. Cells in the cancer field can easily develop into cancer. Removal of the main tumor mass might leave the cancer field behind, increasing risk of recurrence.

METHODS: The model we propose for the cancer field effect is a hybrid cellular automaton (CA), which includes a multi-layer perceptron (MLP) to compute the effects of the carcinogens on the gene expression of the genes related to cancer development. We use carcinogen interactions that are typically associated with smoking and alcohol consumption and their effect on cancer fields of the tongue.

RESULTS: Using simulations we support the understanding that tobacco smoking is a potent carcinogen, which can be reinforced by alcohol consumption. The effect of alcohol alone is significantly less than the effect of tobacco. We further observe that pairing tumor excision with field removal delays recurrence compared to tumor excision alone. We track cell lineages and find that, in most cases, a polyclonal field develops, where the number of distinct cell lineages decreases over time as some lineages become dominant over others. Finally, we find tumor masses rarely form via monoclonal origin.

PMID:37469932 | PMC:PMC10352683 | DOI:10.3389/frai.2023.1060879

Indian J Community Med. 2023 May-Jun;48(3):401-406. doi: 10.4103/ijcm.ijcm_282_22. Epub 2023 May 30.

ABSTRACT

BACKGROUND: Across the globe, people are seeking integrative and holistic measures to prevent coronavirus (COVID-19) infection in the form of complementary and alternative medicines (CAM) with or without conventional medicines. This study was done to know the extent of CAM use for COVID-19 prophylaxis and to know beliefs and attitudes of people related to CAM use in India.

METHODOLOGY: A pretested and prevalidated questionnaire was circulated on social media. Participants, who completed the online form and gave voluntary consent, were included. The questionnaire included demographic details and questions related to CAM use, preferences with reasons, preparations used, perceived role of CAM in prevention, immunity boosting and side effects, sources of information, etc.

RESULTS: Out of 514 responses, 495 were analyzed. 47.07% of respondents were males and 52.93% were females. 66.9% were using CAM for COVID-19 prophylaxis. The association between age, gender, and profession with CAM use was statistically significant (P < 0.05). 41.1% reported CAM use in the past. 36.6% of CAM users were taking “Kadha” and 33% were using ayurvedic medicines. Other frequently used CAM preparations were chyavanprash, giloy, tulsi, ginger, pepper, cloves, honey, sudarshanghanvati, arsenic-30, lemon juice, cinnamon, steam inhalation, ashwagandha, swasarivati, coronil, and warm saline water gargles. 46.9% of the CAM users were on self-medication and 52.3% preferred CAM over allopathy.

CONCLUSION: Complementary and alternative medicine utilization for COVID-19 prophylaxis is widespread and self-medication is prevalent. As no specific cure is available in conventional systems, people believe in traditional medicines more than conventional, yet confusion exists. There is a need of increasing awareness regarding side effects, drug-drug interactions, and self-medication.

PMID:37469923 | PMC:PMC10353683 | DOI:10.4103/ijcm.ijcm_282_22

Indian J Community Med. 2023 May-Jun;48(3):413-417. doi: 10.4103/ijcm.ijcm_839_22. Epub 2023 May 30.

ABSTRACT

BACKGROUND: “Donation gap” refers to the shortage of organ donors worldwide. The medical/nursing students and various healthcare workers have poor awareness and attitude toward organ donation.

OBJECTIVE: We conducted this study to assess the current level of knowledge and perception regarding cadaver organ donation and transplantation among nursing students and to evaluate the impact of structured training interventions on their baseline knowledge and perception level.

METHODS: It was a single-group pre-post interventional study done by nursing students of one government and one private nursing college.A pre-tested questionnaire was used as a study tool.

STATISTICAL ANALYSIS: Various statistical tests like one-way repeated measure ANOVA, Mauchly’s test of sphericity, and Greenhouse-Geisser correction were used. Pairwise comparisons used Bonferroni corrections.

RESULTS: The pre-test group had the lowest mean knowledge (50.2346, SD = 15.35188), and immediately after training group had the highest (57.3900, SD = 14.34626). After one month, knowledge decreased but was still higher than pretraining (mean = 52.3607, SD = 13.28141).

CONCLUSIONS: The positive attitude of nursing students may augment cadaver organ donation and transplantation in the future. The study has also highlighted the further training needs of the participants.

PMID:37469919 | PMC:PMC10353686 | DOI:10.4103/ijcm.ijcm_839_22

Alcohol (Hanover). 2023 Jul 19. doi: 10.1111/acer.15155. Online ahead of print.

ABSTRACT

BACKGROUND: Effective pharmacologic treatments for comorbid alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD) are lacking. Kappa (κ) opioid receptor antagonists may address this unmet need. Buprenorphine is a κ-opioid antagonist and a partial agonist of mu (μ) opioid receptors, and naltrexone blocks all μ-mediated effects, thus, yielding a pharmacological net effect of a κ-opioid receptor antagonist. This combination was tested in this proof-of-concept study since no specific κ-opioid receptor antagonist was available.

METHODS: Consenting participants were enrolled in a Phase II, multisite, double-blinded, randomized, placebo-controlled trial to evaluate the effectiveness of sublingual buprenorphine combined with extended-release (XR) injectable naltrexone for the treatment of comorbid AUD and PTSD. Eligible participants (n=75) were randomized (1:1:1) to receive either buprenorphine 2mg/d plus naltrexone-XR (n=35), buprenorphine 8mg/d plus naltrexone-XR (n=6) or sublingual plus injectable placebo (n=34) for 12 weeks. The buprenorphine 8mg/d plus naltrexone-XR arm was dropped early due to the negative impact of COVID-19 on enrollment. A binary primary outcome of response at week 8 was defined as a decrease from baseline of ≥10 points on the past week Clinician-Administered PTSD Scale (CAPS-5) and a reduction of ≥1 of past month alcohol risk level, as defined by World Health Organization (WHO) and measured by the Timeline Follow-Back.

RESULTS: Based on the results of a futility analysis, enrollment was stopped prior to reaching initial goal of 90 participants. At the week 8 primary timepoint, there were no statistically significant differences between buprenorphine plus naltrexone-XR and placebo group for the primary composite outcome (OR = 0.63; p-value = 0.52), or the subcomponents of the PTSD outcome (OR = 0.76; p-value = 0.69) and AUD outcome (OR = 0.17; p-value = 0.08). The placebo arm had a significantly higher proportion of participants with ≥1 WHO risk reduction compared to the buprenorphine plus naltrexone-XR arm (OR=0.18, p value = 0.02).

CONCLUSIONS: This is the first study to evaluate the potential of κ-opioid receptor antagonism for the treatment of comorbid AUD and PTSD. The combination of buprenorphine and naltrexone-XR showed no significant improvement over placebo for the composite, PTSD or alcohol measures.

PMID:37468230 | DOI:10.1111/acer.15155

Emerg Med J. 2023 Jul 19:emermed-2022-213057. doi: 10.1136/emermed-2022-213057. Online ahead of print.

ABSTRACT

Clinical risk prediction models can support decision making in emergency medicine, but directing intervention towards high-risk patients may involve a flawed assumption. This concepts paper examines prognostic clinical risk prediction and specifically describes the potential impact of treatment effects in model development studies. Treatment effects may lead to models failing to achieve the aim of identifying the patients most likely to benefit from intervention, and may instead identify patients who are unlikely to benefit from intervention. The paper provides practical advice to help clinicians who wish to use clinical prediction scores to assist clinical judgement rather than dictate clinical decision making.

PMID:37468227 | DOI:10.1136/emermed-2022-213057

Pigment Cell Melanoma Res. 2023 Jul 19. doi: 10.1111/pcmr.13113. Online ahead of print.

ABSTRACT

Sentinel lymph node biopsy (SLNB) provides important prognostic information for early-stage melanomas. However, statistics regarding the survival comparison between SLNB and nodal observation in Asia, where acral lentiginous melanoma (ALM) predominates, are limited. This study aimed to identify if SLNB offered survival benefits over nodal observation in early-stage melanomas in Taiwan. The retrospective study included 227 patients who met the SLNB criteria according to the National Comprehensive Cancer Network guidelines and were treated at National Taiwan University Hospital from June 1997 to June 2021. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards regression models. Of the study population, ALM accounted for 73.1%; 161 patients (70.9%) underwent SLNB and 66 patients (29.1%) were under nodal observation. Multivariate analysis showed significantly improved melanoma-specific survival (hazard ratio [HR], 0.6; p = .02) in the SLNB group. Among those who underwent completion lymph node dissection (CLND), the non-sentinel node positivity rate was 44.4%. Immediate CLND resulted in significantly longer melanoma-specific survival and distant-metastasis-free survival (DMFS) compared to nodal observation. (HR, 0.2; p = .01 for melanoma-specific survival. HR, 0.3; p = .046 for DMFS). In conclusion, SLNB may provide survival benefits of cutaneous melanoma over nodal observation in the Taiwanese population.

PMID:37468225 | DOI:10.1111/pcmr.13113

J Am Coll Cardiol. 2023 Jul 25;82(4):336-349. doi: 10.1016/j.jacc.2023.05.024.

ABSTRACT

BACKGROUND: The relationship between omega-3 fatty acids and atrial fibrillation (AF) remains controversial.

OBJECTIVES: This study aimed to determine the prospective associations of blood or adipose tissue levels of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with incident AF.

METHODS: We used participant-level data from a global consortium of 17 prospective cohort studies, each with baseline data on blood or adipose tissue omega-3 fatty acid levels and AF outcomes. Each participating study conducted a de novo analyses using a prespecified analytical plan with harmonized definitions for exposures, outcome, covariates, and subgroups. Associations were pooled using inverse-variance weighted meta-analysis.

RESULTS: Among 54,799 participants from 17 cohorts, 7,720 incident cases of AF were ascertained after a median 13.3 years of follow-up. In multivariable analysis, EPA levels were not associated with incident AF, HR per interquintile range (ie, the difference between the 90th and 10th percentiles) was 1.00 (95% CI: 0.95-1.05). HRs for higher levels of DPA, DHA, and EPA+DHA, were 0.89 (95% CI: 0.83-0.95), 0.90 (95% CI: 0.85-0.96), and 0.93 (95% CI: 0.87-0.99), respectively.

CONCLUSIONS: In vivo levels of omega-3 fatty acids including EPA, DPA, DHA, and EPA+DHA were not associated with increased risk of incident AF. Our data suggest the safety of habitual dietary intakes of omega-3 fatty acids with respect to AF risk. Coupled with the known benefits of these fatty acids in the prevention of adverse coronary events, our study suggests that current dietary guidelines recommending fish/omega-3 fatty acid consumption can be maintained.

PMID:37468189 | DOI:10.1016/j.jacc.2023.05.024

J Mol Biol. 2023 Aug 1;435(15):168181. doi: 10.1016/j.jmb.2023.168181. Epub 2023 Jun 9.

ABSTRACT

Identifying the common structural elements of functionally related RNA sequences (family) is usually based on an alignment of the sequences, which is often subject to human bias and may not be accurate. The resulting covariance model (CM) provides probabilities for each base to covary with another, which allows to support evolutionarily the formation of double helical regions and possibly pseudoknots. The coexistence of alternative folds in RNA, resulting from its dynamic nature, may lead to the potential omission of motifs by CM. To overcome this limitation, we present D-ORB, a system of algorithms that identifies overrepresented motifs in the secondary conformational landscapes of a family when compared to those of unrelated sequences. The algorithms are bundled into an easy-to-use website allowing users to submit a family, and optionally provide unrelated sequences. D-ORB produces a non-pseudoknotted secondary structure based on the overrepresented motifs, a deep neural network classifier and two decision trees. When used to model an Rfam family, D-ORB fits overrepresented motifs in the corresponding Rfam structure; more than a hundred Rfam families have been modeled. The statistical approach behind D-ORB derives the structural composition of an RNA family, making it a valuable tool for analyzing and modeling it. Its easy-to-use interface and advanced algorithms make it an essential resource for researchers studying RNA structure. D-ORB is available at https://d-orb.major.iric.ca/.

PMID:37468182 | DOI:10.1016/j.jmb.2023.168181

BMJ. 2023 Jul 19;382:e071757. doi: 10.1136/bmj-2022-071757.

NO ABSTRACT

PMID:37468141 | DOI:10.1136/bmj-2022-071757