Tag: nevin manimala

Eye (Lond). 2023 Nov 18. doi: 10.1038/s41433-023-02821-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Glauc-Strat-Fast is a clinical tool recommended by The Royal College of Ophthalmologists to classify glaucoma patients into strata of risk for significant future sight loss and an estimate of resource requirement. The aim of this study was to map the movement of glaucoma patients across stratification boundaries on Glauc-Strat-Fast during the COVID-19 pandemic.

SUBJECTS AND METHODS: Glauc-Strat-Fast was applied to a consecutive sample of 100 primary open angle glaucoma patients in a backlog at Worcestershire Acute Hospitals NHS Trust. Stratification outcomes were compared between clinic visits prior to the COVID-19 pandemic versus the follow-up visit. Patients were stratified twice separately based on their worse eye (i.e., most affected) and better eye (i.e., least affected) according to Glauc-Strat-Fast.

RESULTS: Amount of slippage (difference between target follow-up and actual follow-up) ranged from 2 to 32 months. There was a statistically significant average reduction in visual field mean deviation for better and worse eyes between visits (p = <0.001). At follow-up, no worse eyes were classified as being low risk (green), while 96 were classified as high risk (red). For better eyes, elevation of risk into the highest strata of Glauc-Strat-Fast observed a three-fold increase in patients (19 versus 56) between visits.

DISCUSSION: This retrospective real-world analysis highlights patients’ movement into the highest strata on the Glauc-Strat-Fast tool and demonstrates a significant deterioration in visual outcomes during a period of extensive appointment slippage. The findings demonstrate the utility of Glauc-Strat-Fast as a tool for improved patient management.

PMID:37980397 | DOI:10.1038/s41433-023-02821-4

Sci Rep. 2023 Nov 18;13(1):20204. doi: 10.1038/s41598-023-47661-0.

ABSTRACT

Nosocomial infections are infections that are a leading cause of morbidity and mortality among hospitalized patients, and can lead to higher healthcare costs and longer hospital stays in both developed and developing countries. The objectives of the study were to identify the level of knowledge and perception of patients on nosocomial infection, and to determine the factors affecting the knowledge and perception of patients on nosocomial infection in Federal Medical Centre, Ebute-Metta, Lagos (FMC). A cross-sectional research design was used in carrying out the research among in-patients of FMC where an interview-based semi-structured questionnaire was used for data collection. Patients’ knowledge was categorised as good (≥ 70% score), fair (50-69%) and poor (< 50% score) while perception was grouped as positive and negative. Independent sample T-test and One-way Analysis of Variance was used to assess statistical difference in knowledge scores between categorical variables with 2 and 3 groups respectively. A total of 102 patients gave consent to participate in this study of which 46.1% were male, 27.5% were aged between 38 and 47 years and 69.6% were married. About 24% did not know what is meant by nosocomial infections while 53.9% stated that all hospital-acquired infections are preventable. Less than 19% strongly disagreed that making alcohol rubs mandatory for all visitors would decrease the incidence of nosocomial infections while all strongly agreed that if left untreated, such infections can become life-threatening. Overall, 15.7% showed good knowledge while most patients showed fair knowledge (71.6%) and a negative perception (51%) of nosocomial infections. There was a significant difference in patients’ knowledge of nosocomial infections based on age (0.012). There was also a statistically significant association between age and perception of patients towards nosocomial infections (p = 0.031). This study showed that most patients had fair knowledge as well as negative perception towards nosocomial infections. Age, had an influence on patients’ perception and knowledge of nosocomial infection.

PMID:37980389 | DOI:10.1038/s41598-023-47661-0

Sci Rep. 2023 Nov 18;13(1):20225. doi: 10.1038/s41598-023-47341-z.

ABSTRACT

Pyogenic spondylodiscitis presents significant diagnostic and therapeutic challenges. In Germany, a comprehensive understanding of its epidemiology and inpatient management outcomes is limited, hindering the optimisation of therapeutic strategies. This study aimed to characterise the evolving epidemiological trends of pyogenic spondylodiscitis in Germany, and concurrently evaluate inpatient management strategies and outcomes. We performed a retrospective population-based study of spondylodiscitis cases in Germany from 2005 to 2021, utilising data from the German Federal Statistical Office database. The parameters assessed were incidence trends, demographic characteristics, inpatient management strategies, and inpatient mortality. The study found a significant rise in the population-adjusted incidence of spondylodiscitis in Germany from 2005 to 2021, increasing by 104% from 5.4 to 11.0 cases per 100,000 individuals (p < 0.001). The highest number of diagnoses was recorded in 2019. Age group-adjusted data revealed the largest relative changes in the “90 + ” age group, followed by the “80-89” and “70-79” age groups. These increases were not solely attributable to population changes but were also confirmed after calculating the age-group-adjusted incidence rates. Additionally, our statistical analysis demonstrated that both age and year significantly influenced the incidence of spondylodiscitis. Over the same period, inpatient mortality also surged significantly by 347% (p < 0.001), with the highest increase recorded in the 90 + age group, observing a 2450% rise (p < 0.001). The mean length of inpatient stay decreased by 15% (p < 0.05). Concurrently, there was a significant increase in surgical interventions using spinal stabilisation procedures (p < 0.001), which might suggest a shift in the treatment paradigm for spondylodiscitis. The results underscore a concerning rise in spondylodiscitis incidence and mortality in Germany, particularly affecting the ageing population. A notable shift towards surgical intervention was observed. The data highlights the urgent necessity for high-level evidence studies comparing surgical versus conservative treatment, thereby guiding optimised therapeutic strategies.

PMID:37980371 | DOI:10.1038/s41598-023-47341-z

Behav Res Ther. 2023 Nov 11;171:104436. doi: 10.1016/j.brat.2023.104436. Online ahead of print.

ABSTRACT

BACKGROUND: Positive valence emotions serve functions that may facilitate response to exposure therapy – they encourage approach behavior, diminish perceived threat reactivity, and enhance assimilation of new information in memory. Few studies have examined whether positive emotions predict exposure therapy success and extant findings are mixed.

METHODS: We conducted a secondary analysis of an exposure therapy trial for social anxiety disorder to test the hypothesis that patients endorsing higher trait positive emotions at baseline would display the greatest treatment response. N = 152 participants enrolled in a randomized controlled trial of d-cycloserine augmentation completed five sessions of group exposure therapy. Pre-treatment positive emotionality was assessed using the NEO Five-Factor Inventory. Social anxiety symptoms were assessed throughout treatment by blinded evaluators using the Liebowitz Social Anxiety Scale.

RESULTS: Accounting for baseline symptom severity, multilevel growth curve models revealed that patients with higher pre-treatment positive emotionality displayed faster social anxiety symptom reductions and lower scores at 3-month follow-up. This predictive effect remained significant after controlling for baseline depression and extraversion (without the positive emotionality facet).

CONCLUSIONS: These findings add to emerging evidence suggesting that explicitly targeting and enhancing positive emotions during exposure to perceived threat may improve treatment outcomes for anxiety and fear-based disorders.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT02066792https://clinicaltrials.gov/ct2/show/NCT02066792.

PMID:37979218 | DOI:10.1016/j.brat.2023.104436

Am J Otolaryngol. 2023 Nov 11;45(1):104098. doi: 10.1016/j.amjoto.2023.104098. Online ahead of print.

ABSTRACT

INTRODUCTION: Iatrogenic injury to the larynx, particularly the vocal cords from prolonged intubation, has been well-studied; however, tracheal injuries are rarely reported. This study investigates the effectiveness of cuffed, high-volume, low-pressure endotracheal tubes in preventing the development of tracheal ulcers in intubated subjects.

METHODS: A retrospective, IRB-approved review was performed on 1355 subjects who underwent percutaneous tracheostomy from 2002 to 2018. The presence and severity of tracheal ulcers were collected using documentation and photos during percutaneous tracheostomy placement. Primary outcome measures included: the length of time on a ventilator until tracheostomy (LOVT), length of hospitalization (LOH), and mortality in relationship to the severity of the tracheal injury. Data was reported as n (%) and median (IQR). The differences in means between groups were analyzed by ANOVA and Chi-square test with an alpha of 0.05.

RESULTS: 206 subjects met the inclusion criteria; 65 subjects had an absence of tracheal injury, and 141 subjects developed tracheal ulcers. Subjects with tracheal ulcers were grouped by the following severity scale: no ulcer; mild ulcer (minimal mucosal erosion with exudate); moderate ulcer (mucosal erosion); and severe (tracheal ring exposure). There were no statistically significant differences in age (p = 0.99), gender (p = 0.83), BMI (p = 0.44), LOH (p = 0.88), LOVT (p = 0.93), and mortality (p = 0.306) between subjects with differing severity of ulcers. The average annual incidence of clinically significant ulcers (moderate and severe) was 2.2 %.

CONCLUSIONS: The lack of statistical correlation between the duration of intubation and tracheal ulcer severity, along with a low annual incidence of tracheal ulcers, supports the improved safety of high-volume, low-pressure cylindrical, cuffed endotracheal tubes. This study is among the first to specifically focus on injuries at the level of the cuff and tip of endotracheal tubes with implications in preventive measures and potential product design changes.

PMID:37979216 | DOI:10.1016/j.amjoto.2023.104098

Horm Behav. 2023 Nov 16;157:105445. doi: 10.1016/j.yhbeh.2023.105445. Online ahead of print.

ABSTRACT

Sex is ubiquitous and variable throughout the animal kingdom. Historically, scientists have used reductionist methodologies that rely on a priori sex categorizations, in which two discrete sexes are inextricably linked with gamete type. However, this binarized operationalization does not adequately reflect the diversity of sex observed in nature. This is due, in part, to the fact that sex exists across many levels of biological analysis, including genetic, molecular, cellular, morphological, behavioral, and population levels. Furthermore, the biological mechanisms governing sex are embedded in complex networks that dynamically interact with other systems. To produce the most accurate and scientifically rigorous work examining sex in neuroendocrinology and to capture the full range of sex variability and diversity present in animal systems, we must critically assess the frameworks, experimental designs, and analytical methods used in our research. In this perspective piece, we first propose a new conceptual framework to guide the integrative study of sex. Then, we provide practical guidance on research approaches for studying sex-associated variables, including factors to consider in study design, selection of model organisms, experimental methodologies, and statistical analyses. We invite fellow scientists to conscientiously apply these modernized approaches to advance our biological understanding of sex and to encourage academically and socially responsible outcomes of our work. By expanding our conceptual frameworks and methodological approaches to the study of sex, we will gain insight into the unique ways that sex exists across levels of biological organization to produce the vast array of variability and diversity observed in nature.

PMID:37979209 | DOI:10.1016/j.yhbeh.2023.105445

J Aging Soc Policy. 2023 Nov 18:1-24. doi: 10.1080/08959420.2023.2284570. Online ahead of print.

ABSTRACT

Policies aimed at increasing employment among older people often focus on the statutory retirement age. Taking into account the characteristics of workers and work-related factors, we examine the impact of reaching the statutory retirement age on continuing employment. In addition to the use of survival trees, we propose a novel method to predict the probability of staying in employment based on an ensemble of survival trees. We focus on Poland as an example of a European country with a particularly low share of older workers in the labor force. Moreover, reform was carried out in Poland in 2017, lowering the previously raised pension eligibility age. Like other EU countries, pension eligibility in Poland starts after reaching the statutory retirement age. Our results suggest that the timing of retirement is determined by the statutory retirement age to a limited extent compared to other factors. In the case of women, a match of education and occupation, the employment sector, and holding a managerial position had a greater impact on continuing employment than reaching retirement age. In the case of men, the type of job contract had the greatest impact on continuing employment. Our findings indicate that the policies and initiatives aimed at extending working life should pay more attention to work-related factors and gender differences in employment.

PMID:37979192 | DOI:10.1080/08959420.2023.2284570

Bull Hosp Jt Dis (2013). 2023 Dec;81(4):279-284.

ABSTRACT

PURPOSE: The purpose of this study was to systematically review the evidence in the literature in order to evaluate the outcomes following medial patellofemoral ligament (MPFL) reconstruction with allograft compared to autograft reconstruction.

METHODS: A systematic literature search was performed based on PRISMA guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Inclusion criteria for the study was clinical studies reporting on MPFL reconstruction with allograft. Recurrence rate, complications, rate of return-to-play, and functional outcomes including the Kujala, Tegner, and visual analog scale (VAS) scores were evaluated. Statistical analysis was performed using GraphPad Prism 8.3.

RESULTS: Our review identified 12 studies with a total of 336 patient knees meeting the inclusion criteria. The majority of patients were female (61.6%), with a mean age of 22.3 years and a mean follow-up of 43.4 months. The overall rate of recurrence of lateral patellar instability was 2.7% in the allograft cohort as compared to 7.8% in the autograft cohort (p = 0.01). The mean Kujala score was 91.8%, and the mean VAS score was 1.3 at final follow-up. Additionally, 81.5% of patients were able to return to play in the studies reporting this outcome measure. The overall complication rate was 1.4%.

CONCLUSION: The overall rate of recurrence was lower following MPFL reconstruction with allograft as compared to autograft in the treatment of lateral patellar instability. Additionally, there were excellent patient reported outcomes and a low complication rate following the use of allograft for MPFL reconstructionPurpose: The purpose of this study was to systematically review the evidence in the literature in order to evaluate the outcomes following medial patellofemoral ligament (MPFL) reconstruction with allograft compared to autograft reconstruction.

METHODS: A systematic literature search was performed based on PRISMA guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Inclusion criteria for the study was clinical studies reporting on MPFL reconstruction with allograft. Recurrence rate, complications, rate of return-to-play, and functional outcomes including the Kujala, Tegner, and visual analog scale (VAS) scores were evaluated. Statistical analysis was performed using GraphPad Prism 8.3.

RESULTS: Our review identified 12 studies with a total of 336 patient knees meeting the inclusion criteria. The majority of patients were female (61.6%), with a mean age of 22.3 years and a mean follow-up of 43.4 months. The overall rate of recurrence of lateral patellar instability was 2.7% in the allograft cohort as compared to 7.8% in the autograft cohort (p = 0.01). The mean Kujala score was 91.8%, and the mean VAS score was 1.3 at final follow-up. Additionally, 81.5% of patients were able to return to play in the studies reporting this outcome measure. The overall complication rate was 1.4%.

CONCLUSION: The overall rate of recurrence was lower following MPFL reconstruction with allograft as compared to autograft in the treatment of lateral patellar instability. Additionally, there were excellent patient reported outcomes and a low complication rate following the use of allograft for MPFL reconstruction.

PMID:37979146

Bull Hosp Jt Dis (2013). 2023 Dec;81(4):273-278.

ABSTRACT

PURPOSE: The use of intraoperative technology is increasing among orthopedic surgeons in the United States. However, there is continued debate as to whether intraoperative technologies provide clinical benefits in patients undergoing total knee arthroplasty (TKA). This study sought to determine whether the use of a novel intraoperative navigation technology produces equivalent or superior short-term outcomes compared to conventional technique.

METHODS: Fifty-nine consecutive patients underwent primary TKA with a novel imageless intraoperative navigational technology between October 2019 and January 2020 at a single, urban, orthopedic specialty hospital. A 1:1 cohort propensity matching was performed with patients with similar demographics who underwent primary TKA without the use of technology. Demographics, clinical data, as well as preoperative and 3-month Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR) scores were collected. Demographic differences, clinical data, and mean KOOS, JR scores were assessed using chi-squared analysis for categorical variables and independent sample t-test for continuous variables.

RESULTS: Upon 1:1 cohort matching, patients in both the navigational cohorts and non-navigational cohorts were statistically similar demographically. Length of stay (2.11 vs. 1.71 days; p = 0.108), surgical time (108.89 vs. 101.19 minutes, p = 0.066), discharge disposition (p = 0.675), 90- day readmissions (4 vs. 4, p = 0.999), and 90-day reoperations (2 vs. 2, p = 0.999) did not statistically differ between the two matched cohorts. Additionally, KOOS, JR scores evaluated between the two cohorts preoperatively (46.06 vs. 45.17, p = 0.836) and at 3-month follow-up (57.63 vs. 55.06, p = 0.580) were similar.

CONCLUSION: This study demonstrates that the use of this novel intraoperative navigational technology yields similar short-term TKA results when compared to conventionally performed TKA. Further studies are required to validate new technologies and determine their effect on long-term clinical and patient-reported outcomes.

PMID:37979145

Bull Hosp Jt Dis (2013). 2023 Dec;81(4):259-264.

ABSTRACT

BACKGROUND: Deep surgical site infections (dSSI) following total knee arthroplasty (TKA) are associated with morbidity and poor outcomes. Although numerous patient and non-patient factors have been correlated with dSSI development, the temporal and seasonal variability of dSSI is unclear. The purpose of this study was to investigate the monthly and seasonal variability of dSSI rates following TKA.

METHODS: The dSSI database at a single large, urban, academic medical center was reviewed for TKAs performed between January 2009 and August 2018. The monthly and seasonal variability of dSSI was evaluated using a Poisson regression. Additionally, the change in dSSI rate was calculated over the entire study period.

RESULTS: We reviewed 15,230 consecutive TKAs. The average dSSI rate following TKA was 1.11% (SD: 0.91). The rate of dSSI decreased over the study period (r = 0.94, 95% CI: 0.85-1.05) but did not reach statistical significance. With summer as the reference season, there were no significant differences in the dSSI rate in fall, winter, or spring. With July as the reference season, there were no differences in the dSSI rate in any other months of the year.

CONCLUSION: Although non-significant, this analysis found a decreasing rate of dSSI after TKA over a nearly 10-year period. Interestingly, there was no difference in the dSSI rate following TKA in July as compared to other months or in summer as compared to other seasons. This conflicts with previous reports that have found an increased incidence of dSSI and other complications in July when the graduate medical education calendar begins.

PMID:37979143