Tag: nevin manimala

Nurse Res. 2022 Oct 13. doi: 10.7748/nr.2022.e1842. Online ahead of print.

ABSTRACT

BACKGROUND: Questionnaires are perhaps the most widely used measuring tools in nursing research, as many studies conducted by nurses focus on understanding the underlying complex factors that are amenable to questionnaires. However, most questionnaires used in nursing research continue to display inadequate evidence of validity under the traditional methods while ignoring the modern Rasch techniques with better proofs of objective measurement.

AIM: To draw researchers’ attention to the recurrent limitations of the classical approach to questionnaire design and to suggest advanced psychometric analysis exemplified in Rasch methodology as a more appropriate alternative.

DISCUSSION: For questionnaire data to be suitable for statistical analysis, transparent demonstration of mathematical assumptions embodied in the questionnaire is compulsory. The failure to engage contemporary measurement models in designing good questionnaires raises concerns about researchers’ awareness of the application and usefulness of the evidence generated by the modern approach. This paper illustrates with examples the problems inherent in the traditional or classical test theory and advanced dimensionality and category functioning as requisite psychometric properties of a questionnaire. It also outlines several diagnostic parameters that proponents of Rasch techniques recommend for testing.

CONCLUSION: Traditional methods of assessing and analysing a questionnaire’s psychometric properties are no longer tenable because the modern Rasch approach offers exemplary proofs of questionnaire validity rooted in objective measurement theories.

IMPLICATIONS FOR PRACTICE: Nurse researchers using questionnaires for clinical decisions and education purposes should apply the fundamental principles of objective measurements demonstrated in Rasch theory.

PMID:36226577 | DOI:10.7748/nr.2022.e1842

Monaldi Arch Chest Dis. 2022 Oct 11. doi: 10.4081/monaldi.2022.2412. Online ahead of print.

ABSTRACT

The long-term sequelae of COVID-19 have now become more common and appreciable. The SARS-CoV-2 virus can cause a variety of infectious and non-infectious pulmonary complications. The purpose of this study is to raise awareness about post-COVID-19 pulmonary sequelae, both infectious and non-infectious, in this geographical area. A retrospective study was conducted from July 1st 2020 to December 20th 2020. A total of 1200 patients were evaluated, with 83 suffering from post-COVID-19 pulmonary complications. The patients’ mean age was 62 years (IQR 55-69), with 63 (75.9%) being male. The most common co-morbid illnesses were hypertension (49, 59%) and diabetes (45, 54.2%). The majority of them (37, 44.6%) had severe COVID-19, followed by critical COVID-19 (33, 39.8%). There was no statistically significant difference in recurrence of respiratory symptoms or duration of current illness between non-severe, severe, and critical COVID-19 patients. Non-infectious complications were observed in the majority of patients (n=76, 91.5%), including organizing pneumonia/ground glass opacities in 71 (88%) patients, fibrosis in 44 (55%), pulmonary embolism in 10 (12.5%), pneumomediastinum in 6 (7.4%) and pneumothorax in 7 (8.6%). Infective complications (25, 30.1%) included aspergillus infection in 10 (12.0%) and bacterial infection in 5 (8.47%), with more gram-negative infections and one patient developing Mycobacterium tuberculosis. Post COVID-19 mortality was 11 (13.3%). The long-term pulmonary sequelae of COVID-19 are not rare. Cryptogenic organizing pneumonia, ground glass opacities, and fibrosis were common post-COVID-19 sequelae in our patients. This necessitates frequent close monitoring of these patients in order to initiate early appropriate management and prevent further morbidity and eventual mortality.

PMID:36226558 | DOI:10.4081/monaldi.2022.2412

Eur J Transl Myol. 2022 Oct 12. doi: 10.4081/ejtm.2022.10670. Online ahead of print.

ABSTRACT

This study was conducted to evaluate the diagnostic accuracy of the cervical biopsy under colposcopic vision. This retrospective study was performed on 190 women, who were selected from a total of 412 cases referring for colposcopy in one year. All patients underwent colposcopy and loop electrosurgical excision procedure (LEEP). After the investigation of demographic characteristics and data confirmation, colposcopic characteristics were examined. Then, the diagnostic indicators and diagnostic accuracy of the cervical biopsy under colposcopic vision were determined. The mean age of patients was 35.51± 5.91 years. In smokers, the percentage of cancer and CIN3 cases was higher than in normal individuals, and this difference was statistically significant in terms of the frequency of cancerous lesions (P = 0.2). A comparison of colposcopic biopsy with LEEP has shown that the frequency of advanced cases in LEEP has been detected more, and the correlation coefficient (kappa) indicated the weak agreement between the findings of colposcopically directed biopsy (CDB) and LEEP methods. (k = 0.23). The diagnostic accuracy of the cervical biopsy under colposcopic vision for cervical cancer is effectively high. It is recommended that this procedure be performed to diagnose cancerous lesions; however, contrary to what is seen in colposcopy, malignant cases may be spreading and follow-up of patients can affect therapeutic performance.

PMID:36226527 | DOI:10.4081/ejtm.2022.10670

J Korean Neurosurg Soc. 2022 Oct 14. doi: 10.3340/jkns.2022.0126. Online ahead of print.

ABSTRACT

OBJECTIVE: C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count are inflammatory markers used to evaluate postoperative infections. Although these markers are non-specific, understanding their normal kinetics after surgery may be helpful in the early detection of postoperative infections. To compliment the recent trend of reducing the duration of antibiotic use, this retrospective study investigated the inflammatory markers of patients who had received antibiotics within 24 hours after surgery according to the Health Insurance Review & Assessment Service guidelines and compared them with those of patients who had received antibiotics for 5 days, which was proven to be non-infectious.

METHODS: We enrolled 74 patients, divided into two groups. Patients underwent posterior lumbar interbody fusion (PLIF) at a single institution between 2019 and 2020. Group A included 37 patients who received antibiotics within 24 hours after the PLIF procedure, and group B comprised 37 patients who had used antibiotics for 5 days. A 1 : 1 nearest-neighbor propensity-matched analysis was used. The clinical variables included age, sex, medical history, body mass index, estimated blood loss, and operation time. Laboratory data included CRP, ESR, and WBC, which were measured preoperatively and on postoperative days (POD) 1, 3, 5, and 7.

RESULTS: CRP dynamics tended to decrease after peaking on POD 3, with a similar trend in both groups. The average CRP level in group B was slightly higher than that in group A; however, the difference was not statistically significant. Multiple linear regression analysis revealed operation time, number of fused levels, and estimated blood loss as significant predictors of a greater CRP peak value (r²=0.473, p<0.001) in patients. No trend (a tendency to decrease from the peak value) could be determined for ESR and WBC count on POD 7.

CONCLUSION: Although slight differences were observed in numerical values and kinetics, sequential changes in inflammatory markers according to the duration of antibiotic administration showed similar patterns. Knowledge of CRP kinetics allows the assessment of the degree of difference between the clinical and expected values.

PMID:36226528 | DOI:10.3340/jkns.2022.0126

Regen Med. 2022 Oct 13. doi: 10.2217/rme-2022-0138. Online ahead of print.

ABSTRACT

Aims: Given the logistical issues surrounding intramyocardial cell delivery, we sought to address the efficacy of the simpler, more accessible intracoronary route by re-evaluating REGENERATE-DCM and REGENERATE-IHD (autologous cell therapy trials for heart failure; n = 150). Methods: A retrospective statistical analysis was performed on the trials’ combined data. The following end points were evaluated: left ventricular ejection fraction (LVEF), N-terminal pro brain natriuretic peptide concentration (NT-proBNP), New York Heart Association class (NYHA) and quality of life. Results: This demonstrated a new efficacy signal for intracoronary delivery, with significant benefits to: LVEF (3.7%; p = 0.01), NT-proBNP (median -76 pg/ml; p = 0.04), NYHA class (48% patients; p = 0.01) and quality of life (12 ± 19; p = 0.006). The improvements in LVEF, NYHA and quality of life scores remained significant compared to the control group. Conclusion: The efficacy and logistical simplicity of intracoronary delivery should be taken into consideration for future trials.

PMID:36226504 | DOI:10.2217/rme-2022-0138

Haematologica. 2022 Oct 13. doi: 10.3324/haematol.2022.281180. Online ahead of print.

ABSTRACT

Several complications observed in sickle cell disease (SCD) are influenced by variation in hematological traits (HT), such as fetal hemoglobin (HbF) level and neutrophil count. Previous large-scale genome-wide association studies carried out in largely healthy individuals have identified 1000s of variants associated with HT, which have then been used to develop multiancestry polygenic trait scores (PTS). Here, we tested if these PTS associate with HT in SCD patients and can improve statistical models associated with SCD-related complications. In 2,056 SCD patients, we found that the PTS predicted less HT variance than in non-SCD Africanancestry individuals. This was particularly striking at the Duffy/DARC locus, where we observed an epistatic interaction between the SCD genotype and the Duffy null variant (rs2814778) that led to a two-fold weaker effect on neutrophil count. PTS for these routinely measured HT were not associated with complications in SCD. In contrast, we found that a simple PTS for HbF that includes only six variants explained a large fraction of the phenotypic variation (20.5-27.1%), associated with acute chest syndrome and stroke risk, and improved the statistical modeling of vaso-occlusive crisis rate. Using Mendelian randomization, we found that increasing HbF by 4.8% reduces stroke risk by 39% (P = 0.0006). Taken together, our results highlight the importance of validating PTS in large diseased populations before proposing their implementation in the context of precision medicine initiatives.

PMID:36226494 | DOI:10.3324/haematol.2022.281180

Colorectal Dis. 2022 Oct 13. doi: 10.1111/codi.16370. Online ahead of print.

ABSTRACT

AIM: Due to the introduction of a new implantable pulse generator (IPG), the Interstim II, patients with either a dynamic graciloplasty or an abdominally placed IPG for sacral neuromodulation could not undergo surgery to replace their IPG in case of end of battery life. For these patients, the Medtronic Replacement Adaptor 09106 was created. This retrospective case series aims to study safety and feasibility of the Medtronic Replacement Adaptor 09106 in patients with abdominally placed IPGs.

METHODS: Seventeen patients (11 female, 6 male) received a replacement adaptor with a follow-up of 6 months. Outcome measures consisted of a bowel habit diary. Adverse events were classified using the Clavien-Dindo classification.

RESULTS: Outcome measures in the bowel habit diaries after replacement (feasibility) did not differ significantly from outcome measures before replacement. Adverse events occurred in 4 out of 17 patients (24%): 2 patients initially showed pocket site pain (Clavien-Dindo level I), which resolved without intervention. One patient suffered from poor wound closure (Clavien-Dindo level II), and 1 patient had persisting pocket pain (Clavien-Dindo level IIIa), for which a pocket revision was performed. Statistical analyses were performed making paired comparisons using a Wilcoxon signed rank test.

CONCLUSION: The Medtronic Replacement Adaptor 09106 is a valuable option for patients with dynamic graciloplasty or sacral neuromodulation and abdominal IPG and has complication rates similar to replacement of the Interstim without Replacement Adaptor 09106.

PMID:36226480 | DOI:10.1111/codi.16370

Pediatr Pulmonol. 2022 Oct 13. doi: 10.1002/ppul.26199. Online ahead of print.

ABSTRACT

OBJECTIVES: Extrapulmonary manifestations of bronchiolitis have been previously studied, with some identifying right ventricle (RV) diastolic/systolic dysfunction. We hypothesized that severe cases of bronchiolitis would have cardiac dysfunction resulting an increase N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) values and worse outcomes. Therefore, the objective was to evaluate the existence of cardiac dysfunction and to determine its association to severe bronchiolitis.

METHODS: This prospective cohort study included children hospitalized for bronchiolitis under one year old between January 2019 and March 2020. At admission, an echocardiography was performed and plasma levels of NT-proBNP were measured. To analyze outcomes, the cohort was divided in two groups based on the need for positive pressure respiratory support (PPRS), and both were compared to healthy infants.

STATISTICS: bivariant analysis, significant differences p<0.05.

RESULT: One hundred eighty-one patients were included; median age was 2 months. Seventy-three patients required PPRS. Compared to controls, patients requiring PPRS showed worse RV systolic function, with lower tricuspid annular-plane systolic excursion (p=0.002) and parameters of worse right and left diastolic function (trans-tricuspid E and A wave (p=0.004 and p=0.04, respectively) and tricuspid tissue doppler imaging (TDI) e’ (p=0.003), trans-mitral E and mitral TDI a’ (p=0.02and p=0.005, respectively)). A NT-ProBNP greater than 3582 pg/dL predicts the need for longer necessity of PPRS in patients younger than 2 months.

CONCLUSIONS: In addition to the expected RV systolic dysfunction, patients with severe bronchiolitis have parameters of global diastolic worse function possibly secondary to intrinsic myocardial involvement. NT-ProBNP values at admission had strong discriminatory power to predict worse outcomes. This article is protected by copyright. All rights reserved.

PMID:36226478 | DOI:10.1002/ppul.26199

Liver Int. 2022 Oct 13. doi: 10.1111/liv.15455. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Dysregulated iron homeostasis plays an important role in the hepatic manifestation of metabolic-associated fatty liver disease (MAFLD). We investigated the causal effects of five iron metabolism markers, regular iron supplementation, and MAFLD risk.

METHODS: Genetic summary statistics were obtained from open genome-wide association study databases. Two-sample bidirectional Mendelian randomization analysis was performed to estimate the causal effect between iron status and MAFLD, including Mendelian randomization inverse-variance weighted, weighted median methods, and Mendelian randomization-Egger regression. The Mendelian randomization-PRESSO outlier test, Cochran’s Q test, and Mendelian randomization-Egger regression were used to assess outliers, heterogeneity, and pleiotropy, respectively.

RESULTS: Mendelian randomization inverse-variance weighted results showed that the genetically predicted per standard-deviation increase in liver iron (Dataset 2: odds ratio 1.193, 95% confidence interval 1.074-1.326, P=0.001) was associated with an increased MAFLD risk, consistent with the weighted median estimates and Mendelian randomization-Egger regression, although Dataset 1 was not significant. Mendelian randomization inverse-variance weighted analysis showed that genetically predicted MAFLD was significantly associated with increased serum ferritin levels in both datasets (Dataset 1: β=0.038, 95% confidence interval=0.014-0.062, P=0.002; Dataset 2: β=0.081, 95% confidence interval=0.025-0.136, P=0.004), and a similar result was observed with the weighted median methods for Dataset 2 instead of Mendelian randomization-Egger regression.

CONCLUSIONS: This study uncovered genetically predicted causal associations between iron metabolism status and MAFLD. These findings underscore the need for improved guidelines for managing MAFLD risk by emphasizing hepatic iron levels as a risk factor and ferritin levels as a prognostic factor.

PMID:36226474 | DOI:10.1111/liv.15455

Rev Med Suisse. 2022 Oct 12;18(799):1911-1917. doi: 10.53738/REVMED.2022.18.799.1911.

ABSTRACT

This article reviews the clinical implications and limitations of the number needed to treat (NNT). Clinicians can quickly use this rather intuitive statistical value to assess the expected effectiveness of a treatment and explain it to patients. However, careful attention must be paid to the outcomes used in defining an NNT, as well as, the rate of the specific event in the population and the duration of observation. Conflicts of interest may also affect this easily manipulated statistical tool. Some often prescribed treatments have an NNT well above 20, implying an uncertain benefit for the patient, which emphasizes the need to carefully weigh the risk-benefit balance (NNT vs. NNH: number needed to harm) when prescribing. This review shows particularly low NNTs for anti-infectious agents compared to other drugs frequently used in medical practice.

PMID:36226454 | DOI:10.53738/REVMED.2022.18.799.1911