Tag: nevin manimala

BMJ Open. 2023 Oct 17;13(10):e072462. doi: 10.1136/bmjopen-2023-072462.

ABSTRACT

OBJECTIVES: To investigate trends in the incidence rate and main indication for revision hip replacement (rHR) over the past 15 years in the UK.

DESIGN: Repeated national cross-sectional study from 2006 to 2020.

SETTING/PARTICIPANTS: rHR procedures were identified from the National Joint Registry for England, Wales, Northern Ireland, the Isle of Man and the States of Guernsey. Population statistics were obtained from the Office for National Statistics.

MAIN OUTCOME MEASURES: Crude incidence rates of rHR.

RESULTS: The incidence rate of rHR doubled from 11 per 100 000 adults in 2006 (95% CI 10.7 to 11.3) to a peak of 22 per 100 000 adults (95% CI 22 to 23) in 2012, before falling to 17 per 100 000 adults in 2019 (95% CI 16 to 17) (24.5% decrease from peak). The incidence rate of rHR reduced by 39% in 2020 compared with 2019 (during the COVID-19 pandemic). The most frequent indications for rHR between 2006 and 2019 were loosening/lysis (27.8%), unexplained pain (15.1%) and dislocation/instability (14.7%). There were incremental increases in the annual number and incidence rates of rHR for fracture, infection, dislocation/instability and a decrease in rHR for aseptic loosening/lysis.

CONCLUSIONS: The incidence rate of rHR doubled from 2006 to 2012, likely due to high early failure rates of metal-on-metal hip replacements. The incidence of rHR then decreased by approximately 25% from 2012 to 2019, followed by a large decrease during the COVID-19 pandemic. The decrease in the number of rHR performed for aseptic loosening/lysis may reflect improved wear and implant longevity. Increased healthcare resource will be required to care for the increasing numbers of patients undergoing rHR for fracture and infection.

PMID:37848303 | DOI:10.1136/bmjopen-2023-072462

BMJ Open. 2023 Oct 17;13(10):e079407. doi: 10.1136/bmjopen-2023-079407.

ABSTRACT

INTRODUCTION: Preschoolers and school-aged children with congenital heart disease (CHD) are at higher risk of attention deficit hyperactivity disorder (ADHD) compared with the general population. To this day, no randomised controlled trial (RCT) aiming to improve attention has been conducted in young children with CHD. There is emerging evidence indicating that parent-child yoga interventions improve attention and reduce ADHD symptoms in both typically developing and clinical populations.

METHODS AND ANALYSIS: This is a single-blind, two-centre, two-arm trial during which 24 children with CHD and their parents will be randomly assigned to (1) a parent-child yoga intervention in addition to standard clinical care or (2) standard clinical care alone. All participants will undergo standardised assessments: (1) at baseline, (2) immediately post-treatment and (3) 6 months post-treatment. Descriptive statistics will be used to estimate the feasibility and neurodevelopmental outcomes. This feasibility study will evaluate: (1) recruitment capacity; (2) retention, drop-out and withdrawal rates during the yoga programme and at the 6-month follow-up; (3) adherence to the intervention; (4) acceptability of the randomisation process by families; (5) heterogeneity in the delivery of the intervention between instructors and use of home-based exercises between participants; (6) proportion of missing data in the neurodevelopmental assessments and (7) SD of primary outcomes of the full RCT in order to determine the future appropriate sample size.

ETHICS AND DISSEMINATION: Ethical approval has been obtained by the Research Ethics Board of the Sainte-Justine University Hospital. The findings will be disseminated in peer-reviewed journals and conferences and presented to the Canadian paediatric grand round meetings.

TRIAL REGISTRATION NUMBER: NCT05997680.

PMID:37848299 | DOI:10.1136/bmjopen-2023-079407

BMJ Open. 2023 Oct 17;13(10):e077702. doi: 10.1136/bmjopen-2023-077702.

ABSTRACT

OBJECTIVE: The implementation of point-of-care ultrasound (POCUS) in general practice varies, but it is unknown what determines this variation. The purpose of this study was to explore (1) the overall proportion of POCUS-users among general practitioners (GPs), (2) the current use of POCUS by GPs, (3) factors related to the implementation of POCUS in general practice and (4) GPs’ concerns related to POCUS use in general practice.

DESIGN: An online survey was distributed in June 2019.

SETTING: General practice.

PARTICIPANTS: GPs working in office-based primary care clinics in Denmark.

MAIN OUTCOME MEASURES: The questionnaire was developed using mixed methods and included questions about participants’ characteristics, past POCUS training and experience, capability, opportunity and motivation for using POCUS in the primary care setting. Results were summarised using descriptive statistics. Association between GPs’ background characteristics and POCUS use was tested using logistics regression.

RESULTS: Responses were analysed from 1216 questionnaires corresponding to 36.4% of all GPs in Denmark. The majority (72.3%) of participants had previous POCUS experience, 14.7% had access to a POCUS device and 11.5% used POCUS. Several factors motivated participants to use POCUS. However, barriers existed such as lack of remuneration and high workload. Additionally, many GPs questioned their ability to scan with sufficient diagnostic accuracy and the impact of POCUS on the consultation. Of non-users, 28.7% believed they would be using POCUS in the future.

CONCLUSION: Although, the majority of GPs had past experience with POCUS and felt motivated to use it, few had implemented POCUS. Several factors influenced the GPs’ capability, opportunity and motivation for using POCUS and several concerns were registered by non-users.

PMID:37848298 | DOI:10.1136/bmjopen-2023-077702

Clin Transplant. 2023 Oct 17:e15166. doi: 10.1111/ctr.15166. Online ahead of print.

ABSTRACT

BACKGROUND: Appendicitis in pancreatic transplant recipients can be challenging to diagnose and manage. Incidental appendicectomy (IA) during pancreas transplantation obviates the risk of appendicitis but potentially at the cost of increased operating time or early post-operative complications. This study reviewed the value of IA at a single center.

METHODS: This was a retrospective study of patients who underwent a pancreas transplant in our unit from January 1st, 2012 to December 31st, 2020, with end of follow-up on May 21st, 2023; recipients were grouped by whether or not an IA was performed during pancreas transplantation. Donor, recipient, operative, and graft outcomes were compared between the two groups. Post-transplant complications related to appendiceal pathology (or IA) were recorded and classified.

RESULTS: Two hundred forty-three patients underwent a pancreas transplant; 227 (93%) patients had an appendix in situ at transplantation, and of these 53 (23%) underwent an IA and 174 (77%) did not. There were no statistically significant differences in operative time (p = .06) or hospital stay (p = .50) between the two groups. In the IA cohort, there were no Clavien-Dindo Grade III-V complications relating to the appendicectomy. In those that did not undergo an IA, two patients (1%) subsequently required appendicectomy due to appendicitis. Comparison of pancreatic graft survival showed no statistically significant difference between the groups (p = .44).

CONCLUSIONS: This study suggests that IA is effective at reducing risks of post-transplant appendiceal complications without significantly prolonging inpatient stay or impairing graft survival. These data support the consideration of undertaking an IA for all patients undergoing a pancreas transplant.

PMID:37848266 | DOI:10.1111/ctr.15166

CMAJ Open. 2023 Oct 17;11(5):E956-E968. doi: 10.9778/cmajo.20210337. Print 2023 Sep-Oct.

ABSTRACT

BACKGROUND: Most children who need emergency care visit general emergency departments and urgent care centres; the weighted pediatric readiness score (WPRS) is currently used to evaluate emergency departments’ readiness for pediatric patients. The aim of this study was to determine whether a higher WPRS was associated with decreased mortality and improved health care outcomes and utilization.

METHODS: We conducted a systematic review of cohort and cross-sectional studies on emergency departments that care for children (age ≤ 21 yr). We searched MEDLINE (Ovid), Embase (Ovid), the Cochrane Library (Wiley), CINAHL (EBSCO), Global Health (Ovid) and Scopus from inception until July 29, 2022. Articles identified were screened for inclusion by 2 independent reviewers. The primary outcome was mortality, and the secondary outcomes were health care outcomes and utilization. We used the Newcastle-Ottawa Scale to assess for quality and bias of the included studies. The I ² statistic was calculated to quantify study heterogeneity.

RESULTS: We identified 1789 articles. Eight articles were included in the final analysis. Three studies showed an inverse association between highest WPRS quartile and pediatric mortality (pooled odds ratio [OR] 0.45, 95% confidence interval [CI] 0.26 to 0.78; I ² = 89%, low certainty of evidence) in random-effects meta-analysis. Likewise, 1 study not included in the meta-analysis also reported an inverse association with a 1-point increase in WPRS (OR 0.93, 95% CI 0.88 to 0.98). One study reported that the highest WPRS quartile was associated with shorter length of stay in hospital (β -0.36 days, 95% CI -0.61 to -0.10). Three studies concluded that the highest WPRS quartile was associated with fewer interfacility transfers. The certainty of evidence is low for mortality and moderate for the studied health care outcomes and utilization.

INTERPRETATION: The data suggest a potential inverse association between the WPRS of emergency departments and mortality risk in children. More studies are needed to refute or confirm these findings.

PROTOCOL REGISTRATION: PROSPERO-CRD42020191149.

PMID:37848258 | DOI:10.9778/cmajo.20210337

Cold Spring Harb Perspect Biol. 2023 Oct 17:a041439. doi: 10.1101/cshperspect.a041439. Online ahead of print.

ABSTRACT

The significance of prezygotic isolation for speciation has been recognized at least since the Modern Synthesis. However, fundamental questions remain. For example, how are genetic associations between traits that contribute to prezygotic isolation maintained? What is the source of genetic variation underlying the evolution of these traits? And how do prezygotic barriers affect patterns of gene flow? We address these questions by reviewing genetic features shared across plants and animals that influence prezygotic isolation. Emerging technologies increasingly enable the identification and functional characterization of the genes involved, allowing us to test established theoretical expectations. Embedding these genes in their developmental context will allow further predictions about what constrains the evolution of prezygotic isolation. Ongoing improvements in statistical and computational tools will reveal how pre- and postzygotic isolation may differ in how they influence gene flow across the genome. Finally, we highlight opportunities for progress by combining theory with appropriate data.

PMID:37848246 | DOI:10.1101/cshperspect.a041439

Acta Neurol Taiwan. 2024 Mar 30;33(1):7-13.

ABSTRACT

PURPOSE: This study aims to investigate the effect of edaravone in preventing cisplatin-induced brain damage.

METHODS: Forty female Wistar albino rats were included in the study. 4 groups were created. In group 1 (control group) (n=10), neither any drugs were given nor anything was performed. Group 2 (cisplatin group) (n=10), single dose 7.5 mg/kg cisplatin was given. In group 3 (edaravone group) (n=10), single dose 1 mg/kg edaravone was administered. Group 4 (cisplatin+ edaravone group) (n=10), single dose 7.5 mg/kg cisplatin and 1 mg/kg edaravone were given. Brain tissue was removed in all rats after 3 days. Blood samples taken from heart tissue were examined for malondialdehyde (MDA) and nitric oxide (NO) levels. Brain tissue was evaluated for damage with p53, GFAP and Ki 67.

RESULTS: Edaravone reduced cisplatin-induced brain damage. MDA and NO levels in the cisplatin group were significantly higher than the other groups (p less than 0.05). Likewise, tissue damage in the cisplatin group was significantly higher than in the other groups (p less than 0.05). The immunohistochemical staining which was done by using p53, GFAP and Ki 67 was shown that tissue damage was higher in cisplatin group than cisplatin+ edaravone group and this difference was found to be statistically significant (p less than 0.05).

CONCLUSION: The findings of our study suggest that edaravone therapy may be effective in the prevention and treatment of cisplatin-induced brain injury.

PMID:37848239

J Dr Nurs Pract. 2023 Oct 17:JDNP-2023-0015.R1. doi: 10.1891/JDNP-2023-0015. Online ahead of print.

ABSTRACT

Background: Mentorship is a vital part of the nursing profession. The evidence suggests that competent mentors aid in facilitating role transitions, improving job satisfaction, enhancing patient care, and decreasing nursing turnover. Advanced practice registered nurses (APRNs) have the skills and knowledge to provide safe, high-quality, patient-centered care; however, they may be lacking in mentorship abilities. Objective: Currently, there is no formal mentorship training in the organization, which may cause variability in the mentoring of new staff. The focus of this project was to create a staff educational intervention to improve the mentoring competency of surgical APRNs. The knowledge gap, lack of mentoring education given to APRNs acting as mentors to novice practitioners, was noted, and this project identified a staff educational intervention on mentorship training that was developed and implemented. Methods: The project practice-focused question asked if a formal APRN mentorship training program geared toward the six elements of mentoring (as measured by the Mentoring Competency Assessment [MCA]) increased the mentoring competency of APRNs serving in a mentorship role. Benner’s theory guided the planning and development of this project, while the MCA was used for the self-reflection survey. Following a pretest survey, participants experienced an educational intervention geared toward mentoring and mentoring competencies. Formal APRN mentorship training program with an educational intervention that addressed the six domains of mentoring competency geared toward increasing the mentoring competency of APRNs who serve in a mentorship role. Results: A total of 18 surgical APRNs (N = 18) with more than 2 years of experience participated in the staff educational intervention. There was a statistically significant difference in six of the 26 individual items and in the overall pretest mean scores and the posttest mean scores (z = -3.41, p < .01), indicating that the APRN mentorship training increased the mentoring competency of the APRNs. Conclusion: The results of this quality improvement project demonstrated how an educational intervention geared toward mentoring competencies can increase the knowledge among a group of APRNs. Educating APRNs in mentorship competencies may enhance mentorship abilities and result in positive patient and organizational outcomes. Implications for Nursing: Educating APRNs in mentorship competencies may enhance mentorship abilities and result in positive patient and organizational outcomes.

PMID:37848236 | DOI:10.1891/JDNP-2023-0015

J Nurs Meas. 2023 Oct 17:JNM-2022-0048.R1. doi: 10.1891/JNM-2022-0048. Online ahead of print.

ABSTRACT

Background and Purpose: Previous research shows significant benefits resulting from improving culturally competent nursing care. Thus, the purpose of this study was to translate, adapt, and validate the Cultural Competence Assessment (CCA) in a sample of Portuguese nurses. Methods: A psychometric study of the CCA, after translation into European Portuguese, was performed with a snowball sample of 284 nurses. Participants were asked to fill in a sociodemographic questionnaire and the CCA. Results: The four-factor model of the CCA (Portuguese version) exhibited satisfactory indices of fitness without item nine. Cronbach’s alpha was 0.85. Correlations between subscales and the total score scale were strong and statistically significant. Conclusions: These data add to the cultural competence knowledge of nurses to promote better practices and culturally competent care.

PMID:37848230 | DOI:10.1891/JNM-2022-0048

Acta Neurol Taiwan. 2024 Jun 30;33(2):55-62.

ABSTRACT

OBJECTIVE: To study the clinico- radiological profile and outcome of isolated paramedian hemipontine infarcts.

MATERIALS AND METHODS: This is a prospective cross- sectional study. 50 consecutive patients admitted between January 2019 and December 2020 with a diagnosis of isolated paramedian hemipontine stroke were included. The locations of the infarcts were classified as follows- caudal; middle; rostral; dorsomedian; caudal and middle; and middle and rostral pons. The clinico- radiological profiles were studied and the outcomes were assessed using NIHSS (National Institutes of Health Stroke Scale) and mRS (modified Rankin score). Data was analysed using SPSS 22 version software. Paired t-test was used as a test of significance to identify the mean differences between the two quantitative variables.

RESULTS: Majority of the subjects were 51- 60 years (34 percent). The most common risk factors were hypertension and type 2 diabetes mellitus. The most common clinical features were hemiparesis and speech disturbances. Pure motor hemiparesis (PMH) is the common syndrome seen in paramedian hemipontine strokes with infarcts located in caudal; middle; caudal and middle; and middle and rostral pons. In ataxic hemiparesis, infarcts were located in dorsomedian pons. In dysarthria clumsy hand syndrome, infarcts were located at rostral pons. 44 percent of the subjects had left vertebral artery abnormality. There was a statistically significant difference in the mean NIHSS and mRS when compared at admission/ discharge and at 3 months.

CONCLUSION: Isolated paramedian hemipontine stroke syndromes have good topographical correlation with patients usually having a good functional outcome at the end of three months.

PMID:37848229