Tag: nevin manimala

Altern Ther Health Med. 2024 Jul 19:AT10474. Online ahead of print.

ABSTRACT

OBJECTIVE: To appraise the application value of psychological counseling based on the concept of solution-focused brief therapy (SFBT) concept in patients with premature ovarian failure.

METHODS: A total of 176 patients with premature ovarian failure admitted to China-Japan Union Hospital hospital between January 2020 and February 2021 were enrolled for prospective analysis and were randomly assigned to the control group and the experimental group using the random number table method, with 88 cases in each group. The control group received the normal psychological counseling intervention, whereas the experimental group received the SFBT-based counseling intervention. The serum indexes follicle-stimulating hormone (FSH), luteinizing hormone (LH), Estradiol (E2), Fertility Quality of Life (FertiQoL) score, Symptom Checklist 90 (SCL-90) score, Memorial University of Newfoundland Scale of Happiness (MUNSH) score, self-rating depression scale (SDS) score, self-rating anxiety scale (SAS) score, and the satisfaction rate were recorded and compared between the two groups of patients.

RESULTS: After the intervention, patients in the experimental group achieved lower FSH and LH levels and higher E2 levels than the control group (P < .05). After the intervention, the scores of emotional response, mind-body relationship, and tolerability and overall scores increased in both groups, with the experimental group scoring significantly higher than the control group (P < .05). After the intervention, the differences in hostility and compulsion scores between the two groups were not statistically significant (P > .05). Compared with the control group, patients in the experimental group scored lower on somatization, interpersonal relationship, and psychosis and overall score, while positive factor scores were higher (P < .05). Before the intervention, SDS and SAS scores were comparable in both groups. In contrast, SDS and SAS scores decreased in both groups and in the experimental group compared to the control group after the intervention. (P < .05).

CONCLUSION: Psychological counseling based on the SFBT concept in patients with premature ovarian failure could improve the patients’ serum indexes, quality of life, and sense of well-being, which is worthy of clinical promotion. It is recommended that most researchers conduct studies with larger samples in our hospital to provide better evidence-based evidence.

PMID:39038342

Altern Ther Health Med. 2024 Jul 19:AT10771. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the diagnostic value of combining ultrasound-guided percutaneous biopsy with serum CA125 and CEA testing in ovarian tumors.

METHODS: Sixty-four patients suspected of having ovarian tumors, admitted to our hospital from July 2021 to July 2023, were selected for the study. All patients underwent ultrasound-guided percutaneous biopsy and serum tumor markers CA125 and CEA level testing. Surgical pathology results were used as the gold standard for comparison. The diagnostic performance of ultrasound-guided percutaneous biopsy alone, serum CA125, serum CEA, and their combination were evaluated. Receiver operating characteristic (ROC) curve analysis was performed, and the sensitivity, specificity, and accuracy were calculated. The differences in diagnostic performance were compared using the chi-square test, with a P < .05 considered statistically significant.

RESULTS: The results of this study demonstrate that combining ultrasound-guided percutaneous biopsy with serum CA125 and CEA testing significantly improved the diagnostic accuracy for ovarian tumors compared to individual testing modalities. Surgical pathology, the gold standard, confirmed 52 malignant and 12 benign tumors among the 64 patients examined. When evaluated individually, the concordance rate between ultrasound-guided biopsy and surgical pathology was 90.63%, while serum CA125 and CEA had diagnostic accuracies of 73.44% and 64.06%, respectively. However, when the two serum markers were used in combination, the diagnostic accuracy increased to 81.25%. Notably, the integration of ultrasound-guided percutaneous biopsy with serum CA125 and CEA testing produced the highest diagnostic accuracy at 95.31%. Statistical analysis confirmed this combined approach had significantly better accuracy, sensitivity, and specificity compared to individual tests (P < .05). ROC curve analysis further substantiated the superior diagnostic value of this integrated testing strategy.

CONCLUSION: The findings of this study demonstrate that the integration of ultrasound-guided percutaneous biopsy with serum CA125 and CEA testing markedly enhances diagnostic accuracy for ovarian tumors, with a combined accuracy exceeding 95%. This integrated diagnostic protocol represents a robust and clinically valuable approach that should be more widely adopted to improve early detection and optimize the management of ovarian neoplasms. The implementation of this combined testing strategy has the potential to significantly impact clinical decision-making and patient outcomes in the diagnosis and treatment of ovarian tumors.

PMID:39038341

Altern Ther Health Med. 2024 Jul 19:AT10332. Online ahead of print.

ABSTRACT

OBJECTIVE: Our aim was to study the clinical effect of a foot correction exerciser used for postoperative rehabilitation in external fixation in high-energy Pilon fracture.

METHODS: From March 2017 to November 2019, 43 patients with AO/OTA type C closed Pilon fractures treated with external fixation were retrospectively analyzed. A total of 23 patients were rehabilitated by foot correction exerciser (1 patient fell off the study), and 20 patients were treated by conventional rehabilitation (2 patients fell off the study). During postoperative hospitalization and regular follow-up after discharge, various indicators were recorded for statistical comparison and evaluation through angle measurement, imaging and questionnaire surveys.

RESULTS: There was no significant difference in postoperative complications in the 2 groups (P > .05). The fracture healing time and stent wearing time in the study group were shorter than in the control group, and the comfort score and functional exercise compliance were higher in the study group than in the control group. The ankle joint mobility was higher in the study group than in the control group at all time points in the first 6 months, and the excellent and good rate of ankle joint function was higher than in the control group, with statistical significance (P < .05).

CONCLUSION: Use of the orthopedic exerciser in the high-energy Pilon fracture external fixation postoperative rehabilitation process and the early introduction of resistance training can reduce pain and soft tissue edema and improve the degree of patient comfort and exercise compliance, accurately measure the force load of the limbs, contribute to the dataization and standardization of rehabilitation exercise programs, accelerate the recovery of joint mobility and improve long-term limb function.

PMID:39038340

Altern Ther Health Med. 2024 Jul 19:AT9793. Online ahead of print.

ABSTRACT

BACKGROUND: Medial unicompartmental knee arthroplasty (UKA) is a surgical procedure that replaces only the damaged medial compartment of the knee joint, preserving the healthy lateral compartment. Previous studies have investigated the impact of body mass index (BMI) on the efficacy of UKA for knee osteoarthritis, but the effect of the ratio of waist circumference to thigh circumference in obese patients has not been reported. This study aimed to explore the impact of the waist-to-thigh ratio on the efficacy of medial UKA in obese patients with knee osteoarthritis.

METHODS: A retrospective analysis was conducted on the clinical data of 99 patients with knee osteoarthritis who underwent medial UKA at our hospital from February 2021 to March 2023. Patients were grouped based on their waist-to-thigh ratio, with a ratio ≤1.7 classified as the normal group and >1.7 as the obese group. Continuous variables such as age, height, weight, surgical indicators, and pain scores were compared between the two groups using the independent samples t test or Mann-Whitney U test, depending on the normality of data distribution. Categorical variables like gender, comorbidities, and patient satisfaction were analyzed using the chi-square test or Fisher’s exact test. Repeated measures ANOVA was used to compare changes in outcome measures over time between the two groups. P < .05 was considered statistically significant. Surgical indicators, hematological indicators, pain status, postoperative recovery, daily living abilities, risk of pressure ulcers and falls, nutritional status, and patient satisfaction were compared between the two groups using the appropriate statistical tests.

RESULTS: This study included 51 patients in the normal group and 48 in the obese group, with no significant differences in baseline characteristics except for gender, BMI, thigh circumference, waist circumference, and waist-to-thigh ratio. The normal group had significantly shorter hospitalization time (5.2 ± 1.3 vs 7.1 ± 2.1 days, P < .001) and surgical time (65.3 ± 11.4 vs 78.6 ± 14.2 minutes, P < .001) compared to the obese group. There were no differences in intraoperative blood loss or time to achieve 90° flexion-extension. Postoperatively, the normal group had lower Visual Analog Scale (VAS) pain scores at all timepoints up to 2 months (P < .05). They also ambulated sooner (2.1 ± 0.6 vs 3.5 ± 1.1 days, P < .001) and discontinued crutches earlier (22.4 ± 4.2 vs 29.1 ± 5.3 days, P < .001) compared to the obese group. Within 1 year, a higher proportion of normal group patients could squat (84.3% vs 62.5%, P = .012). The normal group also had a lower incidence of patellofemoral pain (5.9% vs 18.8%, P = .045).

CONCLUSION: Patients with a high waist-to-thigh ratio (>1.7) experienced poorer outcomes after medial UKA, including higher postoperative pain, slower recovery, and greater incidence of patellofemoral pain compared to those with a normal ratio. These findings suggest that medial UKA may not be the optimal treatment for obese patients with a disproportionately large waist circumference relative to thigh size. Preoperative weight loss or alternative surgical approaches may be considered for these high-risk patients to improve their outcomes. Further research is needed to develop targeted interventions for this patient population.

PMID:39038335

Altern Ther Health Med. 2024 Jul 19:AT9304. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to explore the risk factors and dietary status of middle-aged and elderly people at high risk of stroke in urban and rural areas of Xiangtan City, with a view to providing a basis for formulating stroke prevention and control strategies in urban and rural areas of Xiangtan City.

METHODS: Using the cluster sampling method, a total of 8,453 permanent residents aged ≥40 years old were selected from Yuetang Street, Yuetang District, and Jiangshe Town, Yuhu District, Xiangtan City in 2020 and 2021 for face-to-face questionnaire surveys to collect their demographic information, daily life Method, family history, height, weight, waist circumference, blood pressure, blood sugar, blood lipids, glycosylated hemoglobin, homocysteine and other indicators, and analyze them.

RESULTS: A total of 8453 permanent residents were screened in this study, and a total of 1804 stroke high-risk patients (including stroke and TIA, 21.34%) were screened out, including 973 urban residents (23.53%), and 831 rural residents (19.25%), and the distinction had statistical significance (P < .05); 263 stroke sufferers were screened out, and the prevalence ratio was 3.11%. The exposure rates of risk factors for high-risk groups in urban and rural areas of Xiangtan City from high to low are hypertension, dyslipidemia, smoking, family history of stroke, diabetes, obesity, lack of exercise and atrial fibrillation or heart valve disease. The high-risk groups for urban strokes The proportions of lack of exercise (23.54%) and obesity (38.44%) were significantly higher than the proportions of lack of exercise (17.09%) and obesity (22.64%) in rural areas. The high-risk groups in rural areas had hypertension (87.73%) and a history of TIA (2.89%). The proportion of patients with hypertension (82.43%) and TIA history (1.34%) was significantly higher than those in urban areas, and the differences were statistically significant (P < .05). The proportion of rural residents who eat a salty diet (17.93%) and eat fruits ≤2 days/week (93.98%) is significantly higher than that of urban residents who eat a salty diet (14.49%) and eat fruits ≤2 days/week (59.61%). There are differences. Statistically significant (P < .05), the proportion of urban residents who consume vegetables ≤2 days/week (11.91%) is significantly lower than the proportion of urban residents who consume vegetables ≤2 days/week (28.98%) (P < .01).

CONCLUSION: The high-risk factors for stroke in Xiangtan City are mainly hypertension, dyslipidemia, smoking history, family history of stroke, and diabetes. Tailored public health measures should be taken by residents to address the different risk status and dietary habits of urban and rural populations. Especially dietary intervention for rural residents.

PMID:39038328

Altern Ther Health Med. 2024 Jul 19:AT9967. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim was to investigate the factors associated with cough persistence after thoracoscopic lung cancer resection in elderly lung cancer patients and preventive strategies.

METHODS: In this study, 103 elderly patients with lung cancer who attended the department of thoracic surgery of our hospital from March 2019 to January 2023 were selected for retrospective analysis, all of whom underwent thoracoscopic lung cancer resection and were divided into the cough group (n = 37) and the no-cough group (n = 66) based on the presence or absence of persistent cough in the postoperative period. The clinical data of the patients were analyzed using univariate analysis and multifactorial logistic regression analysis.

RESULTS: The findings of the study show that there was no statistically significant difference when comparing the data of the two groups in terms of gender, age, history of diabetes mellitus, history of hypertension, pathologic type, TNM stage, intraoperative blood loss, and postoperative pleural fluid (P > .05). However, multifactorial analysis showed that preoperative history of smoking, the side of the operation being the right side, the extent of the operation being the lobes of the lungs, the time of tracheal intubation ≥172 min, the peritracheal lymph node clearance, and the occurrence of postoperative acid reflux were independent risk factors for the occurrence of persistent cough in patients after thoracoscopic lung cancer resection, while preoperative respiratory training was a protective factor (P < .05).

CONCLUSION: There are many factors affecting persistent cough after thoracoscopic lung cancer resection. These factors need to be paid close attention to in the clinic and preventive measures should be taken to minimize the occurrence of persistent cough and promote postoperative recovery.

PMID:39038316

Altern Ther Health Med. 2024 Jul 19:AT8981. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the current state of nurses’ intentions to report harmful incidents in the hematology department, and the influencing factors, to provide a relevant basis for ensuring healthcare quality and patient safety.

METHODS: By using a stratified sampling technique, 80 nurses from the hematology department of our hospital between June 2020 and June 2022 were randomly chosen as the research objects. The Chinese version of intention to report adverse event questionnaire (15 items with a scale of 0 to 1), adverse event report cognitive questionnaire (8 items with a scale of 0 to 1), and adverse event reporting attitude questionnaire (25 projects with a scale of 0 to 4) were used to collect data. Multiple linear regression model was used to explore the influencing variables based on the single-factor indicators with statistical significance.

RESULTS: When adverse events caused serious casualties or even death, the majority cases (96.25%) were reported to the superior supervisor; when the adverse events did not cause relevant injury, and was in potential vulnerability, the proportion of discussing with colleagues was the most (90.00% and 88.75%, respectively). For cognition on adverse events, “whether they understand the medical safety event reporting system” accounted for the most proportion (98.75%). The nurses had the highest scores for reporting standard [(25.58 ± 6.19) points] and lowest score for reporting purpose [(8.62 ± 1.51) points]. Age, educational background, years of employment, and professional titles were influencing factors of nurses’ inclination to report unfavorable events (P < .05).

CONCLUSION: The cognition and reporting attitude of nurses in the hematology department on adverse events need further improvement. The intention of the nurses to report adverse events is influenced by age, educational background, years of experience, and professional titles. Patient safety education especially with simulation-based training should be implemented, to decrease frequency of adverse incidents.

PMID:39038315

Ann Intern Med. 2024 Jul 23. doi: 10.7326/M23-3109. Online ahead of print.

ABSTRACT

BACKGROUND: Limited evidence exists on the safety of pharmacokinetic interactions of cytochrome P450 (CYP) 2D6 (CYP2D6)-metabolized opioids with antidepressants among older nursing home (NH) residents.

OBJECTIVE: To investigate the associations of concomitant use of CYP2D6-metabolized opioids and antidepressants with clinical outcomes and opioid-related adverse events (ORAEs).

DESIGN: Retrospective cohort study using a target trial emulation framework.

SETTING: 100% Medicare NH sample linked to Minimum Data Set (MDS) from 2010 to 2021.

PARTICIPANTS: Long-term residents aged 65 years and older receiving CYP2D6-metabolized opioids with a disease indication for antidepressant use.

INTERVENTION: Initiating CYP2D6-inhibiting versus CYP2D6-neutral antidepressants that overlapped with use of CYP2D6-metabolized opioids for 1 day or more.

MEASUREMENTS: Clinical outcomes were worsening pain, physical function, and depression from baseline to quarterly MDS assessments and were analyzed using modified Poisson regression models. The ORAE outcomes included counts of pain-related hospitalizations and emergency department (ED) visits, opioid use disorder (OUD), and opioid overdose and were analyzed with negative binomial or Poisson regression models. All models were adjusted for baseline covariates via inverse probability of treatment weighting.

RESULTS: Among 29 435 identified residents, use of CYP2D6-metabolized opioids concomitantly with CYP2D6-inhibiting (vs. CYP2D6-neutral) antidepressants was associated with a higher adjusted rate ratio of worsening pain (1.13 [95% CI, 1.09 to 1.17]) and higher adjusted incidence rate ratios of pain-related hospitalization (1.37 [CI, 1.19 to 1.59]), pain-related ED visit (1.49 [CI, 1.24 to 1.80]), and OUD (1.93 [CI, 1.37 to 2.73]), with no difference in physical function, depression, and opioid overdose.

LIMITATION: Findings are generalizable to NH populations only.

CONCLUSION: Use of CYP2D6-metabolized opioids concomitantly with CYP2D6-inhibiting (vs. CYP2D6-neutral) antidepressants was associated with worsening pain and increased risk for most assessed ORAEs among older NH residents.

PRIMARY FUNDING SOURCE: National Institute on Aging.

PMID:39038293 | DOI:10.7326/M23-3109

J Med Internet Res. 2024 Jul 22;26:e55757. doi: 10.2196/55757.

ABSTRACT

BACKGROUND: The proliferation of digital technology has the potential to transform diabetes management. One of the critical aspects of modern diabetes management remains the achievement of glycemic targets to avoid acute and long-term complications.

OBJECTIVE: This study aims to describe the landscape of evidence pertaining to the relative effectiveness or efficacy and safety of various digital interventions for the self-management of type 2 diabetes mellitus (T2DM), with a primary focus on reducing glycated hemoglobin A_1c (HbA_1c) levels.

METHODS: A systematic literature review (SLR) was conducted by searching Embase, MEDLINE, and CENTRAL on April 5, 2022. Study selection, data extraction, and quality assessment were performed by 2 independent reviewers. Eligibility criteria for the SLR included randomized controlled trials (RCTs) and comparative observational studies evaluating interventions containing both human (eg, coaching) and digital components (eg, glucose meter) in adult patients with T2DM. The primary meta-analysis was restricted to studies that reported laboratory-measured HbA_1c. In secondary analyses, meta-regression was performed with the intensity of coaching in the digital intervention as a categorical covariate.

RESULTS: In total, 28 studies were included in this analysis. Most studies (23/28, 82%) used the reduction of HbA_1c levels as the primary end point, either directly or as a part of a multicomponent outcome. In total, 21 studies reported statistically significant results with this primary end point. When stratified into 3 intervention categories by the intensity of the intervention supporting the digital health technology (analyzing all 28 studies), the success rate appeared to be proportional to the coaching intensity (ie, higher-intensity studies reported higher success rates). When the analysis was restricted to RCTs using the comparative improvement of HbA_1c levels, the effectiveness of the interventions was less clear. Only half (12/23, 52%) of the included RCTs reported statistically significant results. The meta-analyses were broadly aligned with the results of the SLR. The primary analysis estimated a greater reduction in HbA_1c associated with digital interventions compared with usual care (-0.31%, 95% CI -0.45% to -0.16%; P<.001). Meta-regression estimated reductions of -0.45% (95% CI -0.81% to -0.09%; P=.02), -0.29% (95% CI -0.48% to -0.11%; P=.003), and -0.28% (95% CI -0.65% to 0.09%; P=.20) associated with high-, medium-, and low-intensity interventions, respectively.

CONCLUSIONS: These findings suggest that reducing HbA_1c levels in individuals with T2DM with the help of digital interventions is feasible, effective, and acceptable. One common feature of effective digital health interventions was the availability of timely and responsive personalized coaching by a dedicated health care professional.

PMID:39037772 | DOI:10.2196/55757

JMIR Form Res. 2024 Jul 22;8:e57529. doi: 10.2196/57529.

ABSTRACT

BACKGROUND: Limited guidance exists for analyzing participant engagement in provider-guided digital health interventions (DHIs). System usage is commonly assessed, with acknowledged limitations in measuring socio-affective and cognitive aspects of engagement. Nurse WRITE, an 8-week web-based nurse-guided DHI for managing symptoms among women with recurrent ovarian cancer, offers an opportunity to develop a framework for assessing multidimensional engagement.

OBJECTIVE: This study aims to develop a conceptual and analytic framework to measure socio-affective, cognitive, and behavioral engagement with provider-guided DHIs. We then illustrate the framework’s ability to describe and categorize engagement using Nurse WRITE as an example.

METHODS: A sample of 68 participants from Nurse WRITE who posted on the message boards were included. We adapted a prior framework for conceptualizing and operationalizing engagement across 3 dimensions and finalized a set of 6 distinct measures. Using patients’ posts, we created 2 socio-affective engagement measures-total count of socio-affective engagement classes (eg, sharing personal experience) and total word count-and 2 cognitive engagement measures-total count of cognitive engagement classes (eg, asking information-seeking questions) and average question completion percentage. Additionally, we devised behavioral engagement measures using website data-the total count of symptom care plans and plan reviews. k-Means clustering categorized the participants into distinct groups based on levels of engagement across 3 dimensions. Descriptive statistics and narratives were used to describe engagement in 3 dimensions.

RESULTS: On average, participants displayed socio-affective engagement 34.7 times, writing 14,851 words. They showed cognitive engagement 19.4 times, with an average of 78.3% completion of nurses’ inquiries. Participants also submitted an average of 1.6 symptom care plans and 0.7 plan reviews. Participants were clustered into high (n=13), moderate (n=17), and low engagers (n=38) based on the 6 measures. High engagers wrote a median of 36,956 (IQR 26,199-46,265) words. They demonstrated socio-affective engagement approximately 81 times and cognitive engagement around 46 times, approximately 6 times that of the low engagers and twice that of the moderate engagers. High engagers had a median of 91.7% (IQR 82.2%-93.7%) completion of the nurses’ queries, whereas moderate engagers had 86.4% (IQR 80%-96.4%), and low engagers had 68.3% (IQR 60.1%-79.6%). High engagers completed a median of 3 symptom care plans and 2 reviews, while moderate engagers completed 2 plans and 1 review. Low engagers completed a median of 1 plan with no reviews.

CONCLUSIONS: This study developed and reported an engagement framework to guide behavioral intervention scientists in understanding and analyzing participants’ engagement with provider-guided DHIs. Significant variations in engagement levels across 3 dimensions highlight the importance of measuring engagement with provider-guided DHIs in socio-affective, cognitive, and behavioral dimensions. Future studies should validate the framework with other DHIs, explore the influence of patient and provider factors on engagement, and investigate how engagement influences intervention efficacy.

PMID:39037757 | DOI:10.2196/57529