Tag: nevin manimala

Braz J Cardiovasc Surg. 2024 Nov 28;e20230254(e20230254). doi: 10.21470/1678-9741-2023-0254.

ABSTRACT

OBJECTIVE: To compare the efficacy of isolated off-pump coronary artery bypass grafting (OPCABG) and of coronary artery bypass grafting (CABG) plus mitral valve plasty (MVP) in treating coronary heart disease with moderate ischemic mitral regurgitation to find a better surgical method.

METHODS: Clinical data of 822 patients diagnosed with coronary heart disease and moderate ischemic mitral regurgitation were analyzed retrospectively. Patients were divided into the OPCABG and CABG+MVP groups according to surgical methods. Baseline data of both groups were corrected, and clinical efficacy of the two surgical methods was analyzed and compared using the propensity score inverse probability of treatment weighting (IPTW) method.

RESULTS: There were no significant differences in the use of mammary artery grafts, number of grafts, and blood product consumption between the two groups (P>0.05) after IPTW. However, the CABG+MVP group had a significantly longer operation time than the OPCABG group (4.13 ± 0.85 hours vs. 5.65 ± 1.02 hours, P<0.001). No statistically significant differences in postoperative major adverse cardiac and cerebrovascular events were observed between the two groups. However, the intra-aortic balloon pump rate was higher in the CABG+MVP group than in the OPCABG group (12.3% vs. 25.0%, P=0.012). Although CABG+MVP can improve ischemic mitral regurgitation significantly (95.4% vs. 81.2%, P<0.001), there were no significant differences in the cumulative survival rate and the incidence of major adverse cardiac and cerebrovascular events between the groups (P>0.05) after IPTW.

CONCLUSION: CABG+MVP may not provide more advantage in patients with coronary heart disease and moderate ischemic mitral regurgitation.

PMID:39607971 | DOI:10.21470/1678-9741-2023-0254

N Z Med J. 2024 Nov 29;137(1606):107-109. doi: 10.26635/6965.6701.

ABSTRACT

Disruption to the circadian clock has impacts on health and wellbeing, including impaired immune function and wound healing. It is plausible that the timing of surgical procedures could impact the body’s response to trauma and susceptibility to infections. Using the Health Quality & Safety Commission data on surgical site infections (SSI) we sought to investigate any possible time of day effects on the incidents of recorded infections. All recorded data from June 2017 to July 2021 were extracted for cardiac and orthopaedic operations in New Zealand. The incidence of SSI was calculated for each 4-hour bin of time across the day. There was a total of 87,034 cases in the analysis, of which 1,327 (1.5%) had an infection. Univariately, there was a significant time of day effect, with operations after 8 pm being 3.91 times more likely to have an infection (p<0.001), and operations between 4 pm and 8 pm being 0.71 times more likely (p=0.03) to have an infection compared to operations conducted between 12 pm and 4 pm. However, when age, acuity and American Society of Anesthesiologists score were included in the model, there were no differences in the rate of infection by time of day. This preliminary work suggests that surgical time of day does not significantly impact incidence of surgical infection when other variables are controlled for. However, this work has not considered other factors that may also be important. We plan to link the SSI data with the National Minimum Dataset to investigate these other factors and conduct a more comprehensive analysis.

PMID:39607969 | DOI:10.26635/6965.6701

N Z Med J. 2024 Nov 29;137(1606):73-91.

ABSTRACT

AIM: Mental wellbeing has been one of the most prominent health concerns in Aotearoa New Zealand and has only been exacerbated by the COVID-19 pandemic. Here we explored factors associated with anxiety and happiness in a mid-pandemic climate in Aotearoa.

METHODS: Analyses were performed on the anxiety and happiness scores from the wellbeing survey in December 2020 (Statistics NZ Tatauranga Aotearoa; 30,000 responders contacted for the Household Labour Force Survey). Correlations and general linear models were used to identify significant predictor variables related to anxiety and happiness scores.

RESULTS: A number of factors correlated with both anxiety and happiness, including loneliness, physical health, family wellbeing, financial wellbeing, age and gender. After controlling for many ethnically stratified social burdens, Māori and Pacific populations demonstrated higher levels of happiness. Discrimination was only associated with anxiety, while generalised trust, trust in the police and in the health system all related to happiness.

CONCLUSION: Anxiety and happiness in a mid-pandemic environment shared many related variables spanning physical, social and financial domains. Additionally, anxiety was associated with greater levels of discrimination, and happiness with trust in public services. Here we provide a window into the state of mental wellbeing in Aotearoa during a global health crisis.

PMID:39607965

N Z Med J. 2024 Nov 29;137(1606):63-72. doi: 10.26635/6965.6562.

ABSTRACT

AIM: New Zealand’s Ministry of Health sets three quality metrics for inpatient stroke care: admission to an organised stroke unit within 24 hours (target 80%), appropriate use of reperfusion therapy (target 12% for ischemic stroke) and transfer to rehabilitation services within 7 days (target 80%). Our aim was to evaluate a large Auckland tertiary hospital’s performance against these indicators.

METHODS: A retrospective study of 200 consecutive stroke patients admitted between April 4 and August 1, 2021, was conducted.

RESULTS: Fifty percent (100/200) of patients were admitted to the stroke unit within 24 hours. Sixteen point six percent (27/183) of ischaemic stroke patients received reperfusion therapy. Twenty-four point five percent (49/200) were transferred to rehabilitation services, of which 40.8% (20/49) were within 7 days of presentation. Patients were less likely to be admitted to the stroke unit within 24 hours if not admitted by the stroke service, if admitted out-of-hours or if suffering an inpatient stroke. Timely admission to the stroke unit was associated with receipt of reperfusion therapy, shorter time to inpatient rehabilitation transfer and shorter duration of admission. Patients with inpatient stroke were less likely to be discharged in a timely manner (adjusted hazard ratio [HR] 0.19; 95% CI 0.07-0.50). All-cause mortality during a hospitalisation episode with a stroke diagnosis was likely to occur early in the admission (adjusted HR 1.82; 95% CI 1.01-3.32).

CONCLUSIONS: The hospital met the reperfusion therapy target but fell short on timely stroke unit admission and rehabilitation transfer. An after-hours effect on stroke unit admission was observed, previously undocumented in New Zealand.

PMID:39607964 | DOI:10.26635/6965.6562

N Z Med J. 2024 Nov 29;137(1606):22-39. doi: 10.26635/6965.6654.

ABSTRACT

AIM: The study explored whether the reported experience of primary healthcare differs for survey respondents in Aotearoa New Zealand who self-report having a mental health (MH) condition in comparison with those who do not.

METHOD: Responses to the New Zealand Health Quality & Safety Commission’s adult primary care patient experience survey received from August 2020 to May 2022 were analysed. Comparative analysis of patient-reported experience measures were completed to contrast experiences reported by those with and without a MH condition, with results stratified by ethnicity (Māori/non-Māori), age group and gender. Age/gender-standardised estimates for proportions of positive responses to each question were developed for each group alongside standardised risk differences.

RESULTS: Our sample comprised 201,650 responses, with 21% reporting a current diagnosed MH condition. While most respondents reported positive experiences of primary healthcare, we found a consistent pattern of fewer positive experiences for those with MH conditions across dimensions of care quality, age and gender groups. When responses were separated by ethnicity, this difference was amplified among Māori.

CONCLUSION: This analysis adds to the increasing body of evidence that experience of MH conditions is associated with worse healthcare experiences. It demonstrates that data are available in Aotearoa New Zealand to routinely monitor and report on primary care experiences for this group. Interventions to improve healthcare should focus on care for Māori with MH conditions as a priority.

PMID:39607961 | DOI:10.26635/6965.6654

Braz J Cardiovasc Surg. 2024 Nov 28;e20230241(e20230241). doi: 10.21470/1678-9741-2023-0241.

ABSTRACT

INTRODUCTION: Various cannulation strategies for venoarterial extracorporeal membrane oxygenation (V-A ECMO) support are currently in use according to the clinical urgency and experience of the rescuing team. Although central V-A ECMO is considered more effective than a peripheral approach, the superiority of one cannulation configuration instead of another remains a controversial subject. This study mainly aims to compare the contribution of V-A ECMO circulatory support modalities to patients’ improvement according to various cannulation site strategies and additional usage of intra-aortic balloon pump (IABP).

METHODS: The study design involved the categorization of all patients into two groups: isolated V-A ECMO support and V-A ECMO plus IABP support. Secondly, we divided the patients into four groups considering V-A ECMO cannulation sites, such as central (aorto-atrial), axillo-femoral, femoro-femoral, and jugulo-femoral. We analyzed the parameters regarding the outcome for each group.

RESULTS: When comparing cannulation sites in relation to laboratory parameters for assessing organ perfusion, no statistically significant differences were observed among the groups. We found no statistically significant result within the groups affecting organ perfusion. The complication rates were higher in patients with concomitant IABP support, but the difference was not statistically significant likewise.

CONCLUSION: V-A ECMO provides effective perfusion, no matter which cannulation site is preferred during the decision-making process, and the utilization of IABP support has no additional contribution to the outcomes. We believe that the most suitable strategy should be a tailor-made decision according to the clinical status of patients, the pathology, urgency, and cost-effectiveness.

PMID:39607957 | DOI:10.21470/1678-9741-2023-0241

Diabet Med. 2024 Nov 28:e15489. doi: 10.1111/dme.15489. Online ahead of print.

ABSTRACT

AIM: Gestational diabetes (GDM) poses risks of short- and long-term complications for mother and infant, emphasising the importance of antenatal and postpartum education and support. We aimed to understand the experiences and views of women with GDM in the Republic of Ireland.

METHODS: Women with current or previous GDM were invited to complete an online cross-sectional survey (April-June 2022). Recruitment utilised social media, local media and personal networks. The survey addressed demographics, GDM knowledge and experiences, breastfeeding and weight management during pregnancy and post-pregnancy GDM support needs. Descriptive statistics were conducted, and between-group comparisons were undertaken using the chi-square test. Content analysis was applied to free text data.

RESULTS: Amongst 231 respondents, most were aged 35-39 (42%); 70% experienced a single GDM pregnancy. Only 6% correctly identified their increased level of risk for developing type 2 diabetes. Under half (44.5%) of respondents reported sufficient time with health professionals to address GDM-related questions. Just over half (54.3%) reported attending for diabetes screening at 6-12 weeks postpartum. The majority (66%) expressed a desire for postpartum information, particularly on healthy eating and physical activity. Having a more recent GDM experience was associated with a stronger preference for weaning (p ≤ 0.001) and weight management information (p = 0.025). Qualitative analysis identified inconsistencies in healthcare messaging, significant concerns about a GDM diagnosis’ impact on the pregnancy experience, and financial costs of diagnosis.

CONCLUSIONS: The findings underscore women’s desire for appropriate information and support during and after pregnancy with GDM. Future interventions should address these needs to effectively promote chronic disease prevention after GDM.

PMID:39607953 | DOI:10.1111/dme.15489

Science. 2024 Nov 29;386(6725):1055-1060. doi: 10.1126/science.adi3252. Epub 2024 Nov 28.

ABSTRACT

Low-dimensional quantum systems can host anyons, particles with exchange statistics that are neither bosonic nor fermionic. However, the physics of anyons in one dimension remains largely unexplored. In this work, we realize Abelian anyons in one dimension with arbitrary exchange statistics using ultracold atoms in an optical lattice, where we engineer the statistical phase through a density-dependent Peierls phase. We explore the dynamical behavior of two anyons undergoing quantum walks and observe the anyonic Hanbury Brown-Twiss effect as well as the formation of bound states without on-site interactions. Once interactions are introduced, we observe spatially asymmetric transport in contrast to the symmetric dynamics of bosons and fermions. Our work forms the foundation for exploring the many-body behavior of one-dimensional anyons.

PMID:39607918 | DOI:10.1126/science.adi3252

Endocrinol Diabetes Metab. 2025 Jan;8(1):e70014. doi: 10.1002/edm2.70014.

ABSTRACT

AIMS: Diabetes mellitus is the most common endocrine disease in childhood which significantly impacts quality of life, morbidity and mortality. This study aimed to investigate the socioeconomic background of children with diabetes and their families and to assess its association with diabetes control.

METHODS: This cross-sectional study was conducted in Khartoum State, Sudan, in 2018, at three outpatient diabetes clinics, using standardised questionnaires. We included 138 diabetic children (T1D and T2D) aged 2-18 years using systematic random sampling. Descriptive statistics, economic indicator and inferential statistics were applied using SPSS version 20. An HbA1C level of > 7.0% was set as the cut-point for uncontrolled diabetes. A p-value of < 0.05 was considered statistically significant.

RESULTS: The mean age of the children was 11.1 (3.64) years. Over half of the respondents were not covered by any insurance scheme and 73% lived in urban areas. Mothers had a mean age of 37.3 (7.8), with one-fourth being illiterate, while fathers had a mean age of 45.4 (9.3). Twenty per cent of parents had higher education. Two-thirds of the participants had their HbA1C levels checked within the last 3 months. The prevalence of uncontrolled diabetes was 78.0%. No statistically significant association was found between HbA1C levels and families’ socioeconomic, demographic or clinical characteristics (p > 0.05).

CONCLUSION: Neither children’ nor parents’ characteristics influenced HbA1C level. The high rate of uncontrolled diabetes (78.0%), and other countries showing better profiles of control, suggests the need for exploring other contributing factors. Insulin availability and lack of home glucose monitoring need to be considered. We recommend future prospective studies to consider these factors and use multiple HbA1C measures’ average as a better indicator of diabetic control.

PMID:39607902 | DOI:10.1002/edm2.70014

Eur J Gen Pract. 2024 Dec;30(1):2430507. doi: 10.1080/13814788.2024.2430507. Epub 2024 Nov 28.

ABSTRACT

BACKGROUND: National Action Plans (NAPs) aim to address antimicrobial resistance (AMR) understanding and awareness but struggle to translate targets into clinically relevant guidance for general practice.

OBJECTIVE: To identify and map antibiotic use targets in European general practice and explore if and how these targets are linked to NAPs.

METHODS: A systematic search was carried out in MEDLINE (OVID), EMBASE and SCOPUS, with additional manual searches. The research questions were: What are existing targets for antibiotic use in general practice in the 31 European countries? and How are these targets linked to the NAPs on AMR?. The results are presented narratively.

RESULTS: 77 reports were included, of which 33 focused on national targets and general practice or linking national and local targets. Reports describe local strategies to achieve targets, such as prescriber feedback, benchmarking systems and financial incentives. However, these reports provide aggregated targets for general practice, such as a percentage reduction of antibiotics prescribed. These targets are set in general, for a specific type of antibiotic, for an amount per number of patients, in defined daily doses or items. None of the reports translate national targets into clinically relevant or practical targets for general practitioners.

CONCLUSION: Most European countries have an NAP with established targets, but the type and implementation of these targets vary between nations. Translating national targets into daily clinical practice is challenging and often lacks the involvement of prescribers. Aligning national and local targets would enhance coherence and more effectively contribute to improvements in antibiotic use.

PMID:39607900 | DOI:10.1080/13814788.2024.2430507