Tag: nevin manimala

Eur J Radiol. 2023 Sep 4;167:111080. doi: 10.1016/j.ejrad.2023.111080. Online ahead of print.

ABSTRACT

PURPOSE: The objective of this study was to assess the inappropriateness rate of oncological follow-up CT examinations.

METHODS: Out of 7.000 oncology patients referred for follow-up CT examinations between March and October 2022, a random sample of 10 % was included. Radiology residents assessed the appropriateness using the Italian Society of Medical Oncology (AIOM) guidelines, supervised by senior radiologists. Association between inappropriateness and clinical variables was investigated and variables influencing inappropriateness were analyzed through a binary logistic regression.

RESULTS: Three-hundred-eighty-eight examinations (56.1 %) were consistent with AIOM guidelines. An additional 100 (14.5 %) examinations did not follow the recommended schedule but were nevertheless considered appropriate because of suspected recurrence/progression (10.7 %) or adverse event requiring imaging assessment (3.8 %). Two-hundred-four (29.4 %) examinations were rated as inappropriate. Inappropriateness causes were as follows: CT not included in the relevant guideline (n = 47); CT extended to additional anatomical regions (n = 59); CT requested at a shorter time-interval (n = 98). No statistically significant difference was found in age, sex, scan region, and primary cancer between appropriate and inappropriate examinations. The only variable significantly associated with inappropriateness was being referred by a specific hospital unit named “unit 2” in the study (p = 0.009), which was demonstrated to be the only appropriateness independent predictor (OR 1.952).

CONCLUSION: This study shows that majority of oncological patients referred for follow-up CT follows standard guidelines. However, a non-negligible proportion was rated as inappropriate, mainly due to the shorter time-interval. No clinical variable was associated with inappropriateness, except for referral by a specific hospital unit.

PMID:37683331 | DOI:10.1016/j.ejrad.2023.111080

J Pediatr Nurs. 2023 Sep 6;73:130-136. doi: 10.1016/j.pedn.2023.09.001. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to explore relationships among psychological safety, the principles of high reliability, and safety reporting intentions in pediatric nursing. Patient safety events are underreported and costly. To promote reporting, many healthcare organizations have adopted the high reliability framework with strategies to foster team psychological safety.

DESIGN: A web-based survey was distributed through the Society of Pediatric Nurses and the National Pediatric Nurse Scientist Collaborative. Data were collected from 244 pediatric nurses using a demographic form, Safety Organizing Scale, Team Psychological Safety Scale, and Intention to Report Safety Events Scale. Data were analyzed using logistic and linear regression.

RESULTS: Psychological safety and perception of working in a high reliability organization (HRO) showed positive statistically significant relationships with reporting intentions (p = 0.034). Odds of nurses achieving highest reporting intention scores increased by a factor of 0.3 with each practice year.

CONCLUSIONS: Psychological safety was found to be a predictor for intention to report safety events among pediatric nurses. Findings also demonstrated that nurses’ perceptions of whether they worked in a high reliability setting also profoundly affect their attitude towards reporting.

PRACTICE IMPLICATIONS: Focusing organizational efforts on cultivating psychological safety and embedding the high reliability framework into professional practice may significantly affect attitudes towards safety event reporting.

PMID:37683304 | DOI:10.1016/j.pedn.2023.09.001

J Neuroimmunol. 2023 Aug 30;383:578194. doi: 10.1016/j.jneuroim.2023.578194. Online ahead of print.

ABSTRACT

Altered immune response during pregnancy has been associated with ASD susceptibility. HLA-G is expressed by the trophoblast at the maternal/fetal interface and induces allogenic tolerance toward the fetus. A 14-bp insertion in the HLA-G 3’UTR (rs371194629) was associated with reduced levels of HLA-G. We aimed to assess the influence of the HLA-G*14 bp indel variant in ASD susceptibility and symptomatology in a Brazilian admixed sample. The insertion genotype (14 bp+/14 bp+) was firstly associated with hetero aggression, but statistical significance was lost after correction (p = 0.035, p_corrected = 0.35). No association between the HLA-G variant and susceptibility to ASD or differential clinical manifestations were observed.

PMID:37683302 | DOI:10.1016/j.jneuroim.2023.578194

Cancer Prev Res (Phila). 2023 Sep 8. doi: 10.1158/1940-6207.CAPR-23-0219. Online ahead of print.

ABSTRACT

Tobacco use is implicated in the carcinogenesis of oral squamous cell carcinoma (OSCC), which is associated with poor survival if not diagnosed early. Identification of novel non-invasive, highly sensitive, and cost-effective diagnostic and risk assessment methods for OSCC would improve early detection. Here, we report a pilot study assessing salivary and serum miRNAs associated with OSCC and stratified by smoking status. Saliva and paired serum samples were collected from 23 OSCC patients and 21 healthy volunteers, with an equal number of smokers and non-smokers in each group. Twenty head and neck cancer-related miRNAs were quantified by qPCR (dual-labeled LNA probes) and analyzed by Welch’s t-test (95% confidence interval). Four saliva miRNAs, miR-21, miR-136, miR-3928, and miR-29B, showed statistically significant overexpression in OSCC versus healthy controls (p<0.05). MicorRNA-21 was statistically significantly overexpressed in OSCC smokers versus non-smokers (p=0.006). Salivary miR-21, miR-136, and miR-3928, and serum miR-21 and miR-136, showed statistically significant differential expression in early-stage tumors versus controls (p<0.05), particularly miR-21 in smokers (p<0.005). This pilot study provides a novel panel of saliva and serum miRNAs associated with oral cancer. Further validation as a potential useful index of oral cancer, particularly miR-21 in smokers and early-stage OSCC is warranted.

PMID:37683274 | DOI:10.1158/1940-6207.CAPR-23-0219

AIDS Care. 2023 Sep 8:1-9. doi: 10.1080/09540121.2023.2254548. Online ahead of print.

ABSTRACT

Indicator condition (IC)-guided HIV testing, i.e., testing when diagnosing a condition associated with HIV, is a feasible and cost-effective testing strategy to identify undiagnosed individuals. Assessing determinants for IC-guided testing may identify opportunities for improvement. A survey study based on the Theory of Planned Behaviour (TPB) was conducted among 163 hospital physicians from five specialties in Amsterdam, the Netherlands. Structural equation models were used to determine the association between the TPB domains (i.e., attitude, belief, norms, self-efficacy and behavioural control) and (1) the intention to test as a mediator for HIV testing behaviour (intentional model) and (2) actual HIV testing behaviour (direct model). Both models accounted for the effect of guideline recommendations. Behaviour scored lower than intention on a five-point scale (mean score of 2.8, SD = 1.6 versus 3.8, SD = 1.1; p<0.0001). The direct model had a better fit than the intentional model based on fit statistics. Discrepancies between the determinants most important for intention versus those for behaviour led to the following recommendations: interventions to improve IC-guided testing in hospitals should primarily focus on implementation of guideline recommendations, followed by improving physicians’ attitude towards IC-guided HIV testing and self-efficacy, as these were the most important correlates of actual HIV testing behaviour.

PMID:37683267 | DOI:10.1080/09540121.2023.2254548

AIDS Care. 2023 Sep 8:1-7. doi: 10.1080/09540121.2023.2254547. Online ahead of print.

ABSTRACT

Oral pre-exposure prophylaxis (PrEP) is a critical intervention for HIV prevention among key populations (KP) in Nigeria. However, little is known about its coverage among adolescent and young key populations (AYKP). Using the 2020 Integrated Biological & Behavioural Surveillance Survey conducted among KP, including female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender people (TG), we assessed the awareness and uptake of PrEP among AYKP (15-24 years) in Nigeria. We performed weighted descriptive statistics and logistic regression analyses. Of the 6882 AYKP included in this study, 36.1% were aware of PrEP, ranging from 47.9% in MSM to 19.8% in FSW. Compared with FSW, MSM (aOR = 3.7, 95%CI = 3.22-4.35) and TG (aOR = 2.6, 95%CI = 2.18-2.98) had significant higher odds of PrEP awareness. Among those aware of PrEP, 24.5% had ever taken PrEP. The uptake of PrEP varied by KP group: TG (28.1%), MSM (25.3%), PWID (18.0%), and FSW (14.4%). MSM (aOR = 2.6, 95%CI = 1.72-4.07) and TG (aOR = 2.7, 95%CI = 1.71-4.14) had significant higher odds of PrEP uptake relative to FSW. The awareness and uptake of PrEP among AYKP in Nigeria is low. This calls for more awareness creation about PrEP addressing the barriers that limit its uptake.

PMID:37683258 | DOI:10.1080/09540121.2023.2254547

JMIR Res Protoc. 2023 Sep 8;12:e49020. doi: 10.2196/49020.

ABSTRACT

BACKGROUND: The United States faces a nursing shortage driven by a burnout epidemic among nurses and nursing students. Nursing students are an integral population to fuel the nursing workforce at high risk of burnout and increased rates of perceived stress.

OBJECTIVE: The aim of this paper is to describe WellNurse, a holistic, interdisciplinary, multidimensional longitudinal research study that examines evidence-based interventions intended to reduce burnout and increase resilience among graduate and undergraduate nursing students.

METHODS: Graduate and undergraduate nursing students matriculated at a large public university in the northeastern United States are eligible to enroll in this ongoing, longitudinal cohort study beginning in March 2021. Participants complete a battery of health measurements twice each semester during the fourth week and the week before final examinations. The measures include the Perceived Stress Scale, the Satisfaction with Life Scale, the Oldenburg Burnout Inventory, the Brief Resilience Scale, and the Pittsburgh Sleep Quality Index. Participants are eligible to enroll in a variety of interventions, including mindfulness-based stress reduction, mindful eating, fitness training, and massage therapy. Those who enroll in specific, targeted interventions complete additional measures designed to target the aim of the intervention. All participants receive a free Fitbit device. Additional environmental changes are being implemented to further promote a culture that supports academic well-being, including recruiting a diverse student population through evidence-based holistic admissions, inclusive teaching design, targeted resilience and stress reduction workshops, and cultural shifts within classrooms and curricula. The study design protocol is registered at Open Science Framework (DOI 10.17605/OSF.IO/NCBPE).

RESULTS: The project was funded on January 1, 2022. Data collection started in March 2022. A total of 267 participants have been recruited. Results will be published after each semester starting in December 2023. WellNurse evaluation follows the Rapid Cycle Quality Improvement framework to continuously monitor ongoing project processes, activity outcomes, and progress toward reducing burnout and increasing resilience. Rapid Cycle Quality Improvement promotes the ability to alter WellNurse interventions, examine multiple interventions, and test their effectiveness among the nursing education population to identify the most effective interventions.

CONCLUSIONS: Academic nursing organizations must address student burnout risk and increase resilience to produce a future workforce that provides high-quality patient care to a diverse population. Findings from WellNurse will support evidence-based implementations for public baccalaureate and master’s nursing programs in the United States.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/49020.

PMID:37682598 | DOI:10.2196/49020

J Med Internet Res. 2023 Sep 8;25:e40560. doi: 10.2196/40560.

ABSTRACT

BACKGROUND: The aim of patient segmentation is to recognize patients with similar health care needs. The Finnish patient segmentation service Navigator segregates patients into 4 groups, including a self-acting group, who presumably manages their everyday life and coordinates their health care. Digital services could support their self-care. Knowledge on self-acting patients’ characteristics is lacking.

OBJECTIVE: The study aims are to describe how Navigator assigns patients with diabetes to the 4 groups at nurses’ appointments at a health center, the self-acting patient group’s characteristics compared with other patient groups, and the concordance between the nurse’s evaluation of the patient’s group and the actual group assigned by Navigator (criterion validity).

METHODS: Patients with diabetes ≥18 years old visiting primary care were invited to participate in this cross-sectional study. Patients with disability preventing informed consent for participation were excluded. Nurses estimated the patients’ upcoming group results before the appointment. We describe the concordance (%) between the evaluation and actual groups. Nurses used Navigator patients with diabetes (n=304) at their annual follow-up visits. The self-acting patients’ diabetes care values (glycated hemoglobin [HbA1c], urine albumin to creatinine ratio, low-density lipoprotein cholesterol, blood pressure, BMI), chronic conditions, medication, smoking status, self-rated health, disability (World Health Organization Disability Assessment Schedule [WHODAS] 2.0), health-related quality of life (EQ-5D-5L), and well-being (Well-being Questionnaire [WBQ-12]) and the patients’ responses to Navigator’s question concerning their digital skills as outcome variables were compared with those of the other patients. We used descriptive statistics for the patients’ distribution into the 4 groups and demographic data. We used the Mann-Whitney U test with nonnormally distributed variables, independent samples t test with normally distributed variables, and Pearson chi-square tests with categorized variables to compare the groups.

RESULTS: Most patients (259/304, 85.2%) were in the self-acting group. Hypertension, hyperlipidemia, and joint ailments were the most prevalent comorbidities among all patients. Self-acting patients had less ischemic cardiac disease (P=.001), depression or anxiety (P=.03), asthma or chronic obstructive pulmonary disease (P<.001), long-term pain (P<.001), and related medication. Self-acting patients had better self-rated health (P<.001), functional ability (P<.001), health-related quality of life (P<.001), and general well-being (P<.001). All patients considered their skills at using electronic services to be good.

CONCLUSIONS: The patients in the self-acting group had several comorbidities. However, their functional ability was not yet diminished compared with patients in the other groups. Therefore, to prevent diabetic complications and disabilities, support for patients’ self-management should be emphasized in their integrated care services. Digital services could be involved in the care of patients willing to use them. The study was performed in 1 health center, the participants were volunteers, and most patients were assigned to self-acting patient group. These facts limit the generalizability of our results.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/20570.

PMID:37682585 | DOI:10.2196/40560

JAMA Netw Open. 2023 Sep 5;6(9):e2333060. doi: 10.1001/jamanetworkopen.2023.33060.

ABSTRACT

IMPORTANCE: The months following inpatient psychiatric hospitalization are a period of high risk for suicidal behavior. Sexual and gender minority (SGM) individuals have elevated risk for suicidal behavior, but no prior research has examined whether SGM inpatients have disproportionate risk for suicidal behavior following discharge from psychiatric hospitalization.

OBJECTIVES: To evaluate whether SGM patients have elevated risk for suicidal behavior following discharge from psychiatric hospitalization compared with heterosexual and cisgender patients and to examine whether differences in risk across groups were accounted for by demographic characteristics and clinical factors known to be associated with suicidal behavior.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was conducted from August 2017 to July 2021 among inpatients aged 18 to 30 years who were voluntarily enrolled during psychiatric hospitalization. The study was conducted at an inpatient psychiatric hospital, with prospective data collected via follow-up visits and electronic health records.

MAIN OUTCOMES AND MEASURES: Onset and/or recurrence of suicidal behavior following discharge from psychiatric hospitalization, assessed at follow-up visits and through electronic health records.

RESULTS: A total of 160 patients were included, with 56 sexual minority (SM) and 15 gender minority (GM) patients. The median (IQR) age of the patients was 23.5 (20.4-27.6) years, 77 (48%) reported male sex assigned at birth, and 114 (71%) identified their race as White. During the follow-up period, 33 suicidal behavior events occurred (among 21% of patients). SM (hazard ratio [HR], 2.02; 95% CI, CI, 1.02-4.00; log-rank P = .04) and GM (HR, 4.27; 95% CI, 1.75-10.40; log-rank P < .001) patients had significantly higher risk for suicidal behavior compared with their heterosexual and cisgender counterparts, respectively, in bivariable analyses. Risk between SM and heterosexual patients was not different after controlling for demographic characteristics and clinical factors associated with suicidal behavior. GM patients exhibited elevated risk during the 100 days following discharge even after controlling for demographic and clinical characteristics (HR, 3.80; 95% CI, 1.18-11.19; P = .03).

CONCLUSIONS AND RELEVANCE: Within this cohort study of psychiatric patients, SGM patients had higher risk for suicidal behavior than non-SGM patients following discharge. While SM patients’ risk was accounted for by clinical characteristics, GM patients’ risk for suicidal behavior was not accounted for by their acute psychiatric state on admission. Future studies with larger subsamples of GM individuals are needed, and inpatient clinicians must attend to the unique needs of SGM individuals to ensure they receive affirming services.

PMID:37682570 | DOI:10.1001/jamanetworkopen.2023.33060

Khirurgiia (Mosk). 2023;(9. Vyp. 2):43-53. doi: 10.17116/hirurgia202309243.

ABSTRACT

OBJECTIVE: To evaluate the fluorescence angiography (FA) parameters with Indocyanine green (ICG) and their dynamics in diabetic foot patients after endovascular treatment.

MATERIAL AND METHODS: A single-center prospective non-blinded study was conducted with the inclusion of 47 diabetic foot patients with Chronic limb-threatening ischemia (CLTI). TcPO2 and FA-ICG were done before and after angioplasty. Zones of interest were selected for FA-ICG: the area of minimum and maximum fluorescence, the area of of the largest part of the foot. Also presented are the parameters of FA ICG: Tstart (sec) – the time of occurrence of min fluorescence (Istart, unit) in the zone of interest after the introduction of ICG; Tmax (sec) – the time to achieve max fluorescence (Imax, unit) after the introduction of ICG; Tmax -Tstart (sec) – the difference in the time of reaching Imax and Istart.

RESULTS: The median TcPO2 values indicated the presence of CLTI before revascularization. Technical success of revascularization was achieved in 45 patients. In the postoperative period, statistically significant changes in TcPO2 and Tstart, Tmax, Tmax-Tstar were obtained. A reduction in the time to reach the ICZ to the zones of interest was noted.

CONCLUSION: FA-ICG evaluate the visual and quantitative characteristics of perfusion of soft tissues of the foot. Reducing the time to reach the fluorescent substance in the areas of interest makes it possible to assume the restoration of the main blood flow to the foot. Further investigations are warranted to determine threshold values to predict wound healing and indications for revascularization.

PMID:37682546 | DOI:10.17116/hirurgia202309243