Tag: nevin manimala

Farm Hosp. 2024 Nov 26:S1130-6343(24)00173-9. doi: 10.1016/j.farma.2024.10.013. Online ahead of print.

ABSTRACT

OBJECTIVE: To study medication adherence and persistence among heart failure patients, assess the methods utilized for estimating medication adherence, and identify optimal adherence thresholds and their impact on clinical outcomes.

METHODS: A systematic search will be conducted in PubMed, Embase, CINAHL, Web of Science, and Scopus databases. Observational studies assessing medication adherence or persistence among heart failure patients via electronic healthcare databases will be included. A narrative synthesis will describe medication adherence and persistence reported and methods used to measure it. A meta-analysis will be attempted to evaluate the impact of secondary medication adherence (multiple and by drug class) on clinical outcomes, including hospitalization, emergency visits, and mortality. The I statistic will be employed to study heterogeneity and the GRADE framework to evaluate evidence certainty. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines and is registered with the Prospective Register of Ongoing Systematic Reviews (PROSPERO) CRD42024509542.

DISCUSSION: This study aims to evaluate medication adherence and persistence in heart failure management through electronic health databases, intending to explore widely used measurement methods and their limitations, and to identify adherence thresholds associated with improved clinical outcomes. By examining these aspects, we anticipate proposing enhancements for future research and establishing desired adherence goals. This approach highlights the expected significance of our findings in advancing patient care and research methodologies.

PMID:39603950 | DOI:10.1016/j.farma.2024.10.013

J Plast Reconstr Aesthet Surg. 2024 Oct 28:S1748-6815(24)00668-5. doi: 10.1016/j.bjps.2024.10.028. Online ahead of print.

ABSTRACT

BACKGROUND: Reduction mammaplasties are among the plastic surgery procedures with the highest rates of patient satisfaction. However, the loss of postoperative sensation in the breast and nipple-areolar complex remains a concern. In light of increasing interest in nerve-preservation techniques, we sought to investigate the relationship between retained sensation with overall satisfaction in reduction mammaplasty in current literature.

METHODS: The authors systematically reviewed all studies that reported postoperative sensation and satisfaction in patients who underwent reduction mammaplasty, using the MEDLINE, Embase, Cochrane, CINAHL, and Scopus databases in October 2023. Studies were evaluated for methodological quality using an NIH Quality Assessment Tool. Meta-analyses of proportions were conducted.

RESULTS: A total of 48 studies met the eligibility criteria. The median quality assessment score was 8/10. For 28 studies eligible for statistical analysis, random effects pooled proportion for patients that retained preoperative sensation was 0.78 (95% CI: 0.67-0.87), and for patients that report postoperative satisfaction was 0.94 (95% CI: 0.91-0.97). Overall, the studies reported a relatively wide range of sensation outcomes with consistently high satisfaction scores.

CONCLUSION: The results of this systematic review suggest that other surgical factors (e.g., relief of macromastia symptoms, aesthetic appearance) play a greater role in patient satisfaction compared to sensation retention in reduction mammaplasty. Wide variability in assessment methodologies for both sensation and satisfaction was noted. Standardizing and objectifying measurement techniques, particularly for sensation, will help further characterize the relationship between sensation and satisfaction in future studies.

PMID:39603925 | DOI:10.1016/j.bjps.2024.10.028

Eur Urol Oncol. 2024 Nov 26:S2588-9311(24)00252-9. doi: 10.1016/j.euo.2024.11.004. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Tailored treatment for prostate cancer (PCa) requires accurate risk stratification. This study examines the effectiveness of the European Association of Urology (EAU) classification in predicting long-term PCa-specific mortality (PCSM) and assesses whether an alternative system can improve the identification of patients with low-risk disease.

METHODS: This study included two cohorts of patients with localized PCa: one with screen-detected PCa (n = 1563; S-cohort) and the other with clinically detected PCa (n = 755; C-cohort), all from a population-based, randomized screening study, who underwent primary radical prostatectomy or radiation monotherapy. Patients were stratified according to the traditional EAU risk classification and an alternative risk classification where low-risk disease is adjusted according to contemporary active surveillance (AS) eligibility criteria. The 15-yr time-dependent area under the curve (AUC) and the cumulative incidence of PCSM at 15 yr after diagnosis were assessed for each risk classification and cohort.

KEY FINDINGS AND LIMITATIONS: With a median follow-up of 20 yr in the S-cohort and 12 yr in the C-cohort, the EAU classification demonstrated 15-yr AUCs of 0.76 (95% confidence interval [CI]: 0.71-0.80) and 0.72 (95% CI: 0.65-0.79), respectively, for predicting PCSM. The alternative classification showed a 15-yr AUC of 0.74 (95% CI: 0.69-0.79) in the S-cohort and 0.75 (95% CI: 0.68-0.81) in the C-cohort. The alternative classification identified 45% more men having a low risk in the S-cohort and 83% more in the C-cohort than the EAU classification, with no statistically significant increase in the 15-yr PCSM incidence (S-cohort subhazard ratio: 1.33 [95% CI: 0.66-2.68]; C-cohort subhazard ratio: 0.99 [95% CI: 0.29-3.38]).

CONCLUSIONS AND CLINICAL IMPLICATIONS: The EAU classification predicts PCSM accurately, but an alternative classification, adjusted for AS eligibility, identifies substantially more men as having a low risk. This could enhance AS acceptance and utilization in clinical practice, reducing overtreatment.

PATIENT SUMMARY: This study shows that while a commonly used pretreatment risk classification for prostate cancer predict disease prognosis accurately, an alternative system based on active surveillance eligibility criteria identifies many more men as having a low risk. Adopting this classification could enhance the acceptance and use of active surveillance, reducing unnecessary treatments.

PMID:39603883 | DOI:10.1016/j.euo.2024.11.004

Oral Surg Oral Med Oral Pathol Oral Radiol. 2024 Oct 17:S2212-4403(24)00591-1. doi: 10.1016/j.oooo.2024.10.076. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the potential of near-infrared Raman spectroscopy (RS) in distinguishing between various types of bone, dental hard tissues, and bone graft materials, and to determine the correlation between pixel intensity values (PIVs) in cone beam computed tomography (CBCT) and Raman values.

STUDY DESIGN: A thinly sliced section of mandible was utilized to evaluate cancellous and cortical bone. Extracted human teeth were used to prepare the enamel and dentin samples. Bone graft materials were tested by compacting them into edentulous tooth sockets in a dry human mandible. CBCT and RS scans of the samples were performed. The following RS outcomes were evaluated: 960 cm^-1 phosphate peak location and width, carbonate:phosphate ratio, mineral:matrix ratio, and collagen coiling ratio. One-way ANOVA and primary component analysis (PCA) statistics were used to assess RS outcomes.

RESULTS: The 960 cm^-1 phosphate peak location was able to effectively differentiate between various tissues and graft materials. PCA of the spectra successfully differentiated native bone from graft materials, underscoring the tissue characterization capability of RS. Varied correlations between RS outcomes and CBCT PIVs were observed.

CONCLUSIONS: Various parameters of RS can differentiate between cancellous bone, cortical bone, dental hard tissues, and bone graft materials. The varied correlations between Raman parameters and CBCT PIVs warrant further research to clarify the nature of these relationships.

PMID:39603873 | DOI:10.1016/j.oooo.2024.10.076

Clin Ther. 2024 Nov 26:S0149-2918(24)00324-2. doi: 10.1016/j.clinthera.2024.10.015. Online ahead of print.

ABSTRACT

PURPOSE: Females are at increased lifetime risk of stroke and experience worse outcomes compared with males. Tryptophan metabolism through the kynurenine pathway, resulting in decreased tryptophan concentrations, is associated with poor outcomes (larger infarct volume, higher National Institutes of Health Stroke Scale [NIHSS] score, and increased early mortality). This metabolic pathway activity varies by sex in healthy adults. However, evaluation of potential sex differences in tryptophan metabolism after an acute ischemic stroke (AIS) is lacking and could contribute to the disparate outcomes by sex. This study characterized sex differences in tryptophan metabolism via the kynurenine pathway in patients with AIS.

METHODS: Whole blood from patients with AIS enrolled in the University of Colorado Health Emergency Medicine Specimen Bank was analyzed using high-throughput mass spectrometry-based metabolomics at the time of arrival to the emergency department and at 12, 24, and 48 hours thereafter. Descriptive statistics characterized the cohort and metabolite levels. Potential sex differences in tryptophan metabolites at individual time points and their change over time were estimated using linear regression models to control for known factors influencing metabolite levels, initial NIHSS score, therapeutic interventions, and time to last known well (or symptom onset). A multivariable linear regression model examined the interaction effect between sex and metabolite level (at 12 hours after admission) on 24-hour NIHSS score while controlling for initial metabolite level, initial NIHSS score, time to last known well, factors influencing metabolite level, and factors influencing neurologic outcomes.

FINDINGS: After adjusting for covariates, females with AIS had significantly lower levels of tryptophan at 12 hours after admission compared with males (point estimate, -5.80; P = 0.03). Females and males neither differ in levels of tryptophan, kynurenine, quinolinic acid, or kynurenic acid at any other time point nor did they differ in change in metabolite concentration over time. Only increased quinolinic acid levels across both sexes at 12 hours after admission were associated with increased 24-hour NIHSS scores (point estimate, 0.49; P = 0.0002).

IMPLICATIONS: Overall, females and males have similar levels and changes in tryptophan and kynurenine pathway metabolites after an AIS. However, females have lower levels of tryptophan early after a stroke. Increased quinolinic acid levels across both sexes were associated with worsening neurologic function as measured by an NIHSS score. Future evaluation of alternative metabolic pathways downstream of tryptophan is needed to explain differences in tryptophan levels but similar levels of downstream kynurenine metabolites in females and males with AIS.

PMID:39603869 | DOI:10.1016/j.clinthera.2024.10.015

Ann Work Expo Health. 2024 Nov 27:wxae090. doi: 10.1093/annweh/wxae090. Online ahead of print.

ABSTRACT

OBJECTIVES: Information systems focusing on occupational carcinogen exposure, whether categorized by industry or occupation, play a pivotal role in the prevention of occupational cancers. Recently, the Korean CARcinogen EXposure (K-CAREX) system was developed to assess carcinogen exposure by industry. However, corresponding information categorized by occupation has yet to be developed. This study aimed to develop an occupation-based exposure matrix for occupational carcinogens as an extension of the K-CAREX framework.

METHODS: The Work Environment Measurement Database (WEMD) and the Special Health Examination Database (SHED) were combined to estimate exposure intensity by occupation. The WEMD supplied exposure levels, whereas the SHED provided occupation information. Additionally, the SHED served as the primary data source for constructing an indicator of exposure prevalence by occupation, utilizing standard occupational classification.

RESULTS: A total of 22 carcinogens were selected for evaluating exposure intensity, and 20 carcinogens were selected for assessing exposure prevalence. Exposure intensity and prevalence were assigned to 156 occupational groups based on these carcinogens. For instance, in terms of welding fume exposure, welders were assigned an exposure intensity rating of 3 and exhibited exposure prevalence of 26%.

CONCLUSIONS: Our findings complement the previously developed K-CAREX, which offered an industry-based exposure matrix. The resultant comprehensive K-CAREX, incorporating both industry- and occupation-based matrices, can be utilized for occupational cancer prevention and epidemiological studies.

PMID:39603817 | DOI:10.1093/annweh/wxae090

Public Health Nurs. 2024 Nov 27. doi: 10.1111/phn.13499. Online ahead of print.

ABSTRACT

AIM: Hypertension is one of the most common chronic diseases worldwide. Therefore, it is essential to improve patients’ adherence to treatment in order to control their blood pressure. The present study aims to examine the effect of a smartphone application-supported nursing care program provided by a nurse on medication adherence and achievement of normal systolic and diastolic blood pressure levels among patients diagnosed with primary hypertension and registered at the Family Health Center within the context of patients’ self-management behaviors.

METHODS: A randomized controlled experimental study design. CONSORT flow chart was used in the study. The study sample consisted of 41 hypertensive patients in the intervention group and 41 hypertensive patients in the control group. The intervention group was supported with a smartphone application named “HiperDostum” based on the health belief model, whereas the control group continued to receive standard healthcare services provided by the Family Health Center, to which they were affiliated. Data were collected using the “Patient Information Form,” “Blood Pressure Monitoring Form,” and the “Medication Adherence Self-Efficacy Scale-Short Form.”

RESULTS: It was observed that the intervention group participants had higher medication adherence self-efficacy scale scores when compared to the control group participants. Comparing the blood pressure values by group, time, and group*time interaction, it was determined that there were statistically significant differences in systolic blood pressure values by time and group*time interaction.

CONCLUSION: Considering the widespread use of smartphones and smartphone application-supported nursing care can be successfully used to enhance self-management and improve treatment adherence among hypertensive patients in primary healthcare institutions.

TRIAL REGISTRATION: Registration number: NCT0532140; NAME OF TRIAL REGISTRY: The Effect of Smart Phone Application Supported Nursing Care Program on the Self-Management of Hypertensive Patients.

PMID:39603812 | DOI:10.1111/phn.13499

Eur J Hosp Pharm. 2024 Nov 27:ejhpharm-2024-004218. doi: 10.1136/ejhpharm-2024-004218. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the impact of pharmaceutical care on the number of readmissions and visits to the emergency department due to heart failure 30 days after hospital discharge, based on a programme of continuous pharmaceutical care throughout the care process, and to assess the differences between the control and intervention groups at 90 days after discharge (number of readmissions and visits to the emergency department, time from discharge to new readmission or visit to the emergency department).

METHODS: A single-centre experimental longitudinal prospective open and parallel-group study with balanced randomisation (1:1) was carried out in a tertiary hospital in Spain. Patients with a diagnosis of primary or decompensated heart failure admitted to the Cardiology Service or the Heart Failure and Vascular Risk Unit were recruited between March 2019 and November 2021 and randomly assigned, using a randomised block model, to the control (standard care) or intervention (continuing care model) groups. Epidemiological, clinical and pharmacology data were recorded. As a measure of association, we used the mean difference and the Student’s t-test. A p value of <0.05 was considered significant.

RESULTS: 296 patients were included (150 randomised to the control group, 146 to the intervention group). The results showed no significant differences between the control and intervention groups in the number of readmissions and visits to the emergency department during the 30 days after discharge (p=0.092), but a statistically significant difference was seen at 90 days (p=0.043). The number of days until the first visit to the emergency department or readmission was higher in the intervention group (p=0.021).

CONCLUSIONS: Continuous care and follow-up by the pharmacist 30 days after discharge has a neutral impact on hospital readmissions and visits to the emergency department of patients with heart failure, but it is positive in the 90 days following discharge.

PMID:39603805 | DOI:10.1136/ejhpharm-2024-004218

J Clin Anesth. 2024 Nov 26;100:111706. doi: 10.1016/j.jclinane.2024.111706. Online ahead of print.

ABSTRACT

BACKGROUND: No previous research has specifically investigated the relationship between postoperative glycemic variability (GV) and acute kidney disease (AKD) in patients undergoing cardiac surgery. In this study, several methods of modelling postoperative GV were used to examine the association between GV and AKD risk and subtypes of AKD.

METHODS: We undertook a retrospective study involving a total of 8,090 adult patients from three academic medical centers in Eastern China who underwent cardiac surgery with cardiopulmonary bypass between 2015 and 2023. Seven-day postoperative GV was calculated using the standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE), average daily risk range (ADRR), and time out of target range (TOR). The primary focus was on the occurrence of AKD between 8 and 90 days post-surgery, which was further categorized into persistent AKD and delayed AKD depending on the acute kidney injury (AKI) status in the first 7 days.

RESULTS: During the 8-90 days postoperative period, AKD occurred in 522 out of 8,090 patients (6.5%). Seven-day postoperative GV was significantly and consistently higher in the AKD group (p<0.001 for each metric). After adjusting for relevant covariates, 7-day GV metrics were significantly associated with elevated AKD risk (standardized hazard ratio (SHR):1.20 (95% confidence interval (CI): (1.12 – 1.27) for SD; SHR: 1.30 (95% CI: 1.20 – 1.40) for TOR). GV was correlated with persistent AKD, while no statistically significant association was observed between GV and delayed AKD. Unique cutoff thresholds were calculated for each GV metric to provide a quantitative indicator of high GV, enhancing its practical utility.

CONCLUSIONS: Our study highlights the association between postoperative GV and increased AKD risk, and identifies specific GV thresholds in adults undergoing cardiac surgery.

PMID:39602857 | DOI:10.1016/j.jclinane.2024.111706

Injury. 2024 Nov 19;56(2):112033. doi: 10.1016/j.injury.2024.112033. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the prevalence and influencing factors of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) in trauma patients, and to explore the predictive effect of ASD on PTSD.

METHODS: A prospective study was conducted on patients hospitalized due to injuries. The first survey used the ASD scale to assess the occurrence of ASD. In one month and three months of follow-up after injury, patients were assessed for the occurrence of PTSD by using the PTSD checklist-civilian version.

RESULTS: The prevalence rates of ASD, one-month PTSD, and three-month PTSD in trauma inpatients were 20.7%, 19.5%, and 17.6%, respectively. ASD is a strong predictor of PTSD, and combining it with severe injury and critical illness can improve the sensitivity and positive predictive ability of predicting the occurrence of PTSD (AUC_Max: 0.827). The important predictive factor for the diagnosis of PTSD is the high alert symptom group of ASD. Moreover, the analysis results showed that the season of trauma happened, comatose state, fear state, psychological burden, and pain intensity were the influencing factors for ASD (P<0.05), while critical illness during hospitalization, psychological burden, and pain intensity were the influencing factors for PTSD (P<0.05).

LIMITATIONS: Some patients with minor and extremely serious injuries were overlooked or missed, resulting in selection bias and information bias that could not be completely avoided.

CONCLUSION: Both trauma conditions and clinical features may affect the occurrence of ASD and PTSD in trauma patients. If ASD in trauma patients is identified early and targeted interventions, it may reduce the occurrence and development of PTSD.

PMID:39602847 | DOI:10.1016/j.injury.2024.112033