Tag: nevin manimala

J Eval Clin Pract. 2024 Jul 3. doi: 10.1111/jep.14055. Online ahead of print.

ABSTRACT

OBJECTIVES: Among the provisions within the Affordable Care Act (ACA), expanding Medicaid was arguably the greatest contributor to increasing access to care. For over a decade, researchers have investigated how Medicaid expansion impacted cancer outcomes. Over this same decade, statistical theory illuminated how state-based policy research could be compromised by invalid inference. After reviewing the literature to identify the inference strategies of state-based cancer registry Medicaid expansion research, this study aimed to assess how inference decisions could change the interpretation of Medicaid expansion’s impact on staging, treatment, and mortality in cancer patients.

DATA SOURCES: Cancer case data (2000-2019) was obtained from the Surveillance, Epidemiology, End Results (SEER) programme. Cases included all cancer sites combined, top 10 cancer sites combined, and three screening amenable cancers (colorectal, female breast, female cervical).

STUDY DESIGN: A Difference-in-Differences design estimated the association between Medicaid expansion and four binary outcomes: distant stage, initiating treatment >1 month after diagnosis, no surgery recommendation, and death. Three inference techniques were compared: (1) traditional, (2) cluster, and (3) Wild Cluster Bootstrap.

DATA COLLECTION: Data was accessed via SEER*Stat.

PRINCIPAL FINDINGS: Estimating standard errors via traditional inference would suggest that Medicaid expansion was associated with delayed treatment initiation and surgery recommendations. Traditional and clustered inference also suggested that Medicaid expansion reduced mortality. Inference using Wild Cluster Bootstrap techniques never rejected the null hypotheses.

CONCLUSIONS: This study reiterates the importance of explicit inference. Future state-based, cancer policy research can be improved by incorporating emerging techniques. These findings warrant caution when interpreting prior SEER research reporting significant effects of Medicaid expansion on cancer outcomes, especially studies that did not explicitly define their inference strategy.

PMID:38959383 | DOI:10.1111/jep.14055

Prev Chronic Dis. 2024 Jul 3;21:E49. doi: 10.5888/pcd21.230415.

ABSTRACT

BACKGROUND: Data modernization efforts to strengthen surveillance capacity could help assess trends in use of preventive services and diagnoses of new chronic disease during the COVID-19 pandemic, which broadly disrupted health care access.

METHODS: This cross-sectional study examined electronic health record data from US adults aged 21 to 79 years in a large national research network (PCORnet), to describe use of 8 preventive health services (N = 30,783,825 patients) and new diagnoses of 9 chronic diseases (N = 31,588,222 patients) during 2018 through 2022. Joinpoint regression assessed significant trends, and health debt was calculated comparing 2020 through 2022 volume to prepandemic (2018 and 2019) levels.

RESULTS: From 2018 to 2022, use of some preventive services increased (hemoglobin A_1c and lung computed tomography, both P < .05), others remained consistent (lipid testing, wellness visits, mammograms, Papanicolaou tests or human papillomavirus tests, stool-based screening), and colonoscopies or sigmoidoscopies declined (P < .01). Annual new chronic disease diagnoses were mostly stable (6% hypertension; 4% to 5% cholesterol; 4% diabetes; 1% colonic adenoma; 0.1% colorectal cancer; among women, 0.5% breast cancer), although some declined (lung cancer, cervical intraepithelial neoplasia or carcinoma in situ, cervical cancer, all P < .05). The pandemic resulted in health debt, because use of most preventive services and new diagnoses of chronic disease were less than expected during 2020; these partially rebounded in subsequent years. Colorectal screening and colonic adenoma detection by age group aligned with screening recommendation age changes during this period.

CONCLUSION: Among over 30 million patients receiving care during 2018 through 2022, use of preventive services and new diagnoses of chronic disease declined in 2020 and then rebounded, with some remaining health debt. These data highlight opportunities to augment traditional surveillance with EHR-based data.

PMID:38959375 | DOI:10.5888/pcd21.230415

Rehabil Nurs. 2024 Jul-Aug 01;49(4):E15-E16. doi: 10.1097/RNJ.0000000000000471.

NO ABSTRACT

PMID:38959367 | DOI:10.1097/RNJ.0000000000000471

Rehabil Nurs. 2024 Jul-Aug 01;49(4):E13-E14. doi: 10.1097/RNJ.0000000000000468.

NO ABSTRACT

PMID:38959366 | DOI:10.1097/RNJ.0000000000000468

Rehabil Nurs. 2024 Jul-Aug 01;49(4):125-133. doi: 10.1097/RNJ.0000000000000466.

ABSTRACT

GENERAL PURPOSE: To provide information on the association between risk factors and the development of new or worsened stage 2 to 4 pressure injuries (PIs) in patients in long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), and skilled nursing facilities (SNFs).

TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Compare the unadjusted PI incidence in SNF, IRF, and LTCH populations.2. Explain the extent to which the clinical risk factors of functional limitation (bed mobility), bowel incontinence, diabetes/peripheral vascular disease/peripheral arterial disease, and low body mass index are associated with new or worsened stage 2 to 4 PIs across the SNF, IRF, and LTCH populations.3. Compare the incidence of new or worsened stage 2 to 4 PI development in SNF, IRF, and LTCH populations associated with high body mass index, urinary incontinence, dual urinary and bowel incontinence, and advanced age.

PMID:38959364 | DOI:10.1097/RNJ.0000000000000466

Wound Manag Prev. 2024 Jun;70(2). doi: 10.25270/wmp.23013.

ABSTRACT

BACKGROUND: The knowledge, attitudes, and behaviors of intensive care nurses concerning the prevention of pressure injury (PI) may be positively affected by education.

PURPOSE: To evaluate the effect of web-based training given to nurses on their knowledge of, attitudes about, and behaviors in the prevention of PI.

METHODS: This study was conducted between May 2019 and December 2019 with a pre-test and post-test design. The study sample consisted of 22 nurses and 80 patients. A link to the educational video prepared for the prevention of PIs was sent to the nurses’ mobile phones.

RESULTS: The training had a significant positive effect on nurses’ level of knowledge of and attitudes toward PI prevention (P < .001 and P = .042, respectively). In group 1, comprising 40 patients who received treatment before nurses’ training, 2.5% of patients had stage 1 PI on day 1 and 7.5% had stage 1 PI on day 7, and 2.5% had stage 4 PI on day 7. In group 2, comprising 40 patients who received treatment after nurses’ training, 2.5% of patients had stage 1 PI on day 1 and 2.5% had stage 1 PI on day 7.

CONCLUSION: Nurses’ knowledge of and attitudes and behaviors toward PI prevention were improved following the web-based training, and the stage and rate of PI were lower in patients who received care after nurses received the training.

PMID:38959350 | DOI:10.25270/wmp.23013

Wound Manag Prev. 2024 Jun;70(2). doi: 10.25270/wmp.23077.

ABSTRACT

PURPOSE: This study aimed to assess nursing students’ knowledge levels and attitudes towards the etiology, risk factors, and preventive measures of incontinence-associated dermatitis (IAD) using an escape room game.

DESIGN: A mixed-method study.

SUBJECTS AND SETTING: The sample size of the study was 32 students.

METHODS: Quantitative data obtained with the Knowledge, Attitude and Practice of Nurses in Managing Incontinence-Associated Dermatitis Questionnaire (KAP-IAD-Q) and qualitative data obtained through FGDs following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist were analyzed using a thematic approach.

RESULTS: The average age of the participants was 22.63 ± 0.90, 87.5% of them were female (n=28), and 50% were third (n=16) and fourth-year students (n=16). KAP-IAD-Q total posttest score (88.06+7.00) was found to be high. Data obtained from the FGDs were categorized under 3 main themes: main focus areas during participation in the IAD-themed escape room game; advantages and disadvantages of teamwork in IAD management; and the game’s contribution to a better understanding and classification of IAD.

CONCLUSIONS: The use of the escape room game facilitated high, fast, and efficient learning of IAD knowledge and attitudes. It revealed challenges in collaborative decision-making, accurate diagnosis, distinguishing from other wounds, and attitude development in the management of IAD.

PMID:38959349 | DOI:10.25270/wmp.23077

Wound Manag Prev. 2024 Jun;70(2). doi: 10.25270/wmp.22090.

ABSTRACT

BACKGROUND: Extracorporeal shockwave therapy (ESWT) has been shown to reduce wound dimensions and healing time in chronic wounds and should be considered a valuable tool in the healing of chronic complex lower extremity wounds.

PURPOSE: The aim of this small case series was to evaluate the effect of ESWT on complex chronic wounds in patients with multiple comorbidities in a medically underserved outpatient wound care clinic setting.

METHODS: All patients had baseline wound measurements taken. Pictures of the wounds were also taken at the time of the initial visit. Patients selected for ESWT received weekly treatments for a maximum recorded duration of 12 weeks in the form of focused electro-hydraulic acoustic pulses. Wound beds were cleansed according to standard of care.

RESULTS: Thirteen patients were followed with a total of 18 wounds treated. After retrospectively analyzing the data, 3 subjects and a total of 5 wounds were excluded, leaving 10 total subjects and 13 wounds. Out of these wounds, 12 healed completely by or before week 12 of ESWT. All wounds demonstrated significant wound dimension reduction during the first 12 weeks of treatment.

CONCLUSION: ESWT could offer accessible, fast, safe, and cost-effective management of some complex chronic wounds. Further research is needed to validate these findings.

PMID:38959347 | DOI:10.25270/wmp.22090

Wound Manag Prev. 2024 Jun;70(2). doi: 10.25270/wmp.23028.

ABSTRACT

BACKGROUND: The management of chronic wounds presents a challenge for surgeons. In this pilot study, the authors established a novel auto-grafting approach for chronic wounds and evaluated its efficacy.

PURPOSE: The objective of this pilot study was to observe the clinical efficacy of granulation-embedded skin grafting for the treatment of chronic wounds at high altitudes.

METHODS: The data of 45 patients with chronic wounds were obtained from the medical records of the Yushu People’s Hospital. Patients were divided into stamp skin-grafting and granulation-embedded skin-grafting groups. Skin graft survival rate, wound coverage rate, and wound-healing time were observed and recorded. The length of hospital stay and 1% total body surface area (TBSA) treatment cost were compared.

RESULTS: Significant differences were noted in skin graft survival rate (94% ± 3% vs 86% ± 3%, P < .01), wound coverage rate on postoperative day 7 (61% ± 16% vs 54% ± 18%, P < .01), and wound-healing times (23 ± 2.52 days vs 31 ± 3.61 days, P < .05). The length of hospital stay and 1% TBSA treatment cost were significantly reduced in the granulation-embedded skin grafting group (P < .05).

CONCLUSIONS: Granulation-embedded skin grafting can improve the healing of chronic wounds at high altitudes. These findings provide a new approach to the clinical treatment of chronic wounds.

PMID:38959346 | DOI:10.25270/wmp.23028

Wound Manag Prev. 2024 Jun;70(2). doi: 10.25270/wmp.23037.

ABSTRACT

BACKGROUND: Operating room-acquired pressure injury (PI) is defined as PI that develops within the first 48 to 72 hours after surgery.

PURPOSE: To determine the incidence and risk factors of operating room-acquired PI.

METHODS: This descriptive cross-sectional study was conducted at a university hospital in Turkey between May 20, 2021, and December 20, 2021, and included 309 patients who met the inclusion criteria. The study was reported based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.

RESULTS: Operating room-acquired PI developed in 5.8% of the patients in this study. Moreover, 54.4% of the patients had medical devices, and medical device-acquired PI occurred in 4.2% of these patients (7/168). Patient age, hemodynamic parameters, and albumin level, as well as duration of surgery, were found to affect the development of operating room-acquired PI.

CONCLUSION: Surgical nurses are responsible for both recognizing situations that may result in perioperative PI and taking necessary precautions. It is recommended that nurses identify existing and potential preoperative, intraoperative, and postoperative risks that impair skin integrity and affect tissue oxygenation to reduce the risk of operating room-acquired PI.

PMID:38959344 | DOI:10.25270/wmp.23037