Tag: nevin manimala

J Clin Nurs. 2023 Sep 14. doi: 10.1111/jocn.16872. Online ahead of print.

ABSTRACT

AIM: To examine the multidimensional properties of caregiver burden among family caregivers of patients with advanced cancer in a palliative context.

DESIGN: A sequential, explanatory, mixed-method study was performed.

METHODS: Family caregivers of patients diagnosed with advanced cancer were recruited from a palliative care department of a third-level hospital in Sichuan Province, China. The Caregiver Burden Inventory, Social Support Rating Scale and Connor-Davidson Resilience Scale were used to collect quantitative data, and a total of 150 caregivers were recruited from January 2022 to September 2022. Qualitative data were collected through semi-structured interviews, and a total of 22 caregivers were interviewed from October 2022 to November 2022. Survey data were analysed using descriptive statistics, and the factors of caregiver burden were identified using the Mann-Whitney U test, Kruskal-Wallis H test and Spearman correlations. Interpretative phenomenological analysis was performed to analyse the interview data to initially explore the multidimensions of caregiver burden. The following-a-thread method and convergence coding matrix were used for triangulation to examine the multidimensional properties of caregiver burden.

RESULTS: The participants experienced a moderate level of caregiver burden (32.97 ± 13.09). Through triangulation, six meta-themes and nine meta-subthemes were identified as multidimensional properties of caregiver burden, including physical (too many caring tasks and poor health condition), emotional (strong negative emotions resulting from patients’ suffering and insufficient and ineffective family communication), social (less social interaction and social role conflict) and economic burdens, factors that aggravate burden (prevention and control of COVID-19 and spousal relationship with patients) and factors that mitigate burden (social support).

CONCLUSION: Multiple dimensions of caregiver burden were experienced by family caregivers of patients with advanced cancer in the palliative context. Family-centred palliative care must be further developed.

IMPLICATIONS FOR THE PROFESSION: It is important to develop family-centred palliative care. Therefore, the focus must be on developing a rational understanding of palliative care in public and a culture-oriented death education in palliative units.

IMPACT: This study adopted a mixed-method approach to comprehensively understand the phenomenon of and factors in caregiver burden in the Chinese palliative oncology context. Our findings suggest that family caregivers in palliative oncology experience a moderate level of caregiver burden, with dimensions including physical, emotional, social and economic burdens, among which emotional burden is the most prominent. The findings of this study provide policy makers and nurse practitioners with targets to be addressed in family-centred care in Chinese palliative units.

REPORTING METHOD: The results of this study are reported based on the guidelines of the Mixed-Methods Article Reporting Standards.

PATIENT OR PUBLIC CONTRIBUTION: Eligible caregivers were invited to participate in the study and semi-structured interviews. Nurse managers of the palliative unit helped us access the patient-management system.

PMID:37706353 | DOI:10.1111/jocn.16872

Aesthet Surg J. 2023 Sep 14:sjad303. doi: 10.1093/asj/sjad303. Online ahead of print.

ABSTRACT

BACKGROUND: Textured implants and expanders are associated with an increased risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). As a result, plastic surgeons are utilizing smooth expanders, but many perceive these produce undesirable outcomes including infection, seroma, and lateral displacement.

OBJECTIVES: To compare clinical outcomes of smooth and textured expanders.

METHODS: We retrospectively reviewed breast reconstruction patients from January 2018 to May 2021. Included patients underwent placement of tissue expanders at the time of mastectomy. Primary outcomes included postoperative seroma, infection, malposition, days to final reconstruction, explantation, and need for capsulorrhaphy.

RESULTS: 233 patients were reviewed, and 167 patients met both inclusion and exclusion criteria. There was no statistically significant difference in poor outcomes comparing smooth and textured expanders. Days to final reconstruction was lower with smooth expanders per breast (p = 0.0424). The subpectoral group was associated with an increased likelihood of undergoing capsulorrhaphy (p = 0.004). Prepectoral placement was associated with more seromas (p = 0.0176) and infections (p = 0.0245). Demographic factors included older age as a protective factor for undergoing capsulorrhaphy (OR = 0.962, p = 0.038), obesity increased the risk of infection (OR = 5.683, p = 0.0279) and malposition (OR = 6.208, p = 0.0222) and radiation was associated with malposition (OR = 3.408, p = 0.0246).

CONCLUSIONS: There was no significant difference in poor outcomes comparing smooth and textured expanders. Patient demographics and anatomical plane placement had greater effects on infection, seroma and need for capsulorrhaphy compared to tissue expander texturing.

PMID:37706322 | DOI:10.1093/asj/sjad303

Twin Res Hum Genet. 2023 Sep 14:1-3. doi: 10.1017/thg.2023.37. Online ahead of print.

ABSTRACT

A simple model by which Hardy-Weinberg proportions are attained in a single generation while maintaining gene frequencies is stated and illustrated. The title ‘Quasi-random mating’ is proposed. Confusion about the Hardy-Weinberg principle can be avoided only if there is clear separation between the basic deterministic model and factors influencing a population’s structure. Eighty years passed before C. C. Li coined the term ‘pseudo-random mating’. The lesson taught by Li has not been taken on board.

PMID:37706311 | DOI:10.1017/thg.2023.37

Assessment. 2023 Sep 14:10731911231194996. doi: 10.1177/10731911231194996. Online ahead of print.

ABSTRACT

Researchers and clinicians working within the Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition, Text Rev (DSM-5-TR) framework face a difficult question: what does it mean to have an evidence-based assessment of a nonevidence-based diagnostic construct? Alternative nosological approaches conceptualize psychopathology as (a) hierarchical, allowing researchers to move between levels of description and (b) dimensional, eliminating artificial dichotomies between disorders and the dichotomy between mental illness and mental well-being. In this article, we provide an overview of ongoing efforts to develop validated measures of transdiagnostic nosologies (i.e., the Hierarchical Taxonomy of Psychopathology; HiTOP) with applications for measurement-based care. However, descriptive models like HiTOP, which summarize patterns of covariation among psychopathology symptoms, do not address dynamic processes underlying the problems associated with psychopathology. Ambulatory assessment, well-suited to examine such dynamic processes, has also developed rapidly in recent decades. Thus, the goal of the current article is twofold. First, we provide a brief overview of developments in constructing valid measures of the HiTOP model as well as developments in ambulatory assessment practices. Second, we outline how these parallel developments can be integrated to advance measurement-based treatment. We end with a discussion of some major challenges for future research to address to integrate advances more fully in transdiagnostic and ambulatory assessment practices.

PMID:37706296 | DOI:10.1177/10731911231194996

Aesthet Surg J. 2023 Sep 14:sjad297. doi: 10.1093/asj/sjad297. Online ahead of print.

ABSTRACT

BACKGROUND: As the prevalence of obesity increases, the number of patients seeing body contouring procedures after bariatric surgery for massive weight loss (MWL) is increasing. While the positive impact of bariatric surgery on physical and emotional health is well-described, few studies have investigated psychosocial well-being of patients undergoing body contouring procedures. Psychosocial well-being can impact patient satisfaction and maintenance of weight loss, and is an important area to study.

OBJECTIVE: The aim of this study was to characterize social and psychiatric factors of patients undergoing body contouring surgery, and to evaluate their impact on maintenance of weight loss.

METHODS: A retrospective review was performed of patients who presented to a single institution for body contouring procedures between 2002 and 2018. Demographic details, medical history, psychosocial support, and operative details were collected. Univariate analysis and multinomial logistic regressions were performed using R statistical software (Version 1.3.1093).

RESULTS: A total of 1,187 patients underwent at least one body contouring procedure during the study timeframe. Mean BMI at presentation was 31.21 ± 10.49 kg/m2. Patients diagnosed with obesity at age 18 or older had a significantly greater odds of suffering from Generalized Anxiety Disorder (OR: 1.08, 95% CI: [1.02, 1.15], p= 0.008). Patients with spousal support had 1.93 times higher odds of having maintained post-bariatric weight loss at their 6-month follow up (OR: 1.93, 95% CI: [1.84, 2.01], p= 0.028).

CONCLUSIONS: Social support and age of obesity diagnosis impact psychological well-being and maintenance of weight loss following body contouring procedures.

PMID:37706281 | DOI:10.1093/asj/sjad297

J Magn Reson Imaging. 2023 Sep 14. doi: 10.1002/jmri.29013. Online ahead of print.

ABSTRACT

BACKGROUND: Carotid webs (CaWs) are fibromuscular projections in the internal carotid artery (ICA) that cause mild luminal narrowing (<50%), but may be causative in up to one-third of seemingly cryptogenic strokes. Understanding hemodynamic alterations caused by CaWs is imperative to assessing stroke risk. Time-Average Wall Shear Stress (TAWSS) and Oscillatory Shear Index (OSI) are hemodynamic parameters linked to vascular dysfunction and thrombosis.

PURPOSE: To test the hypothesis: “CaWs are associated with lower TAWSS and higher OSI than mild atherosclerosis or healthy carotid bifurcation.”

STUDY TYPE: Prospective study.

POPULATION: A total of 35 subjects (N = 14 bifurcations with CaW, 11F, age: 49 ± 10, 10 mild atherosclerosis 6F, age: 72 ± 9, 11 healthy 9F, age: 42 ± 13).

FIELD STRENGTH/SEQUENCE: 4D flow/STAR-MATCH/3D TOF/3T MRI, CTA.

ASSESSMENT: 4D Flow velocity data were analyzed in two ways: 1) 3D ROI in the ICA bulbar segment (complex flow patterns are expected) was used to quantify the regions with low TAWSS and high OSI. 2) 2D planes were placed perpendicular to the centerline of the carotid bifurcation for detailed analysis of TAWSS and OSI.

STATISTICAL TESTS: Independent-samples Kruskal-Wallis-H test with 0.05 used for statistical significance.

RESULTS: The percent surface area where low TAWSS was present in the ICA bulb was 12.3 ± 8.0% (95% CI: 7.6-16.9) in CaW subjects, 1.6 ± 1.9% (95% CI: 0.2-2.9) in atherosclerosis, and 8.5 ± 7.7% (95% CI: 3.6-13.4) in healthy subjects, all differences were statistically significant (ƞ² = 0.3 [95% CI: 0.05-0.5], P-value CaW vs. healthy = 0.2). OSI had similar values in the CCA between groups (ƞ² = 0.07 [95% CI: 0.0-0.2], P-value = 0.5), but OSI was significantly higher downstream of the bifurcation in CaW subjects compared to atherosclerosis and normal subjects. OSI returned to similar values between groups 1.5 diameters distal to the bifurcation (ƞ² = 0.03 [95% CI: 0.0-0.2], P-value = 0.7).

CONCLUSION: Lower TAWSS and higher OSI are present in the ICA bulb in patients with CaW when compared to patients with atherosclerotic or healthy subjects.

EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

PMID:37706274 | DOI:10.1002/jmri.29013

Pediatrics. 2023 Sep 14:e2022061011. doi: 10.1542/peds.2022-061011. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 vaccine is important for children with sickle cell disease (SCD). This quality improvement project’s objective was to increase the proportion of children with SCD receiving ≥2 COVID-19 vaccine doses to ≥70% by June 2022.

METHODS: We used the Model for Improvement framework. We assessed COVID-19 vaccination rates biweekly. Three plan-do-study-act cycles focusing on patient education, provider awareness, and access were performed. Process measures included the outcome of outreach calls and educational video views. Missed clinic appointments was our balancing measure. Line graphs and statistical process control charts were used to track changes. Interrupted time series was used to model implementation rates while accounting for preexisting trends.

RESULTS: A total of 243 patients were included. During the preintervention (September 2021-January 2022) and intervention periods (February 2022-June 2022), overall vaccination rates increased from 33% to 41% and 41% to 64%, respectively. Mean vaccination rate in eligible children in each 2-week period increased from 2.1% to 7.2%. The achieved vaccination rate was 11% greater than predicted for patients with SCD. For the general population the achieved vaccination rate was 23% lower than predicted. The proportion of missed visits did not change (9.0% vs. 9.6%). During outreach calls, 10 patients (13.5%) booked a vaccine. Forty percent of patients watched the promotional video.

CONCLUSIONS: A significant number of patients with SCD are not vaccinated against COVID-19. Targeting misinformation and improving vaccine access aided in increasing vaccination. Additional interventions are needed as a large number of patients remain unvaccinated.

PMID:37706252 | DOI:10.1542/peds.2022-061011

J Neurophysiol. 2023 Sep 14. doi: 10.1152/jn.00194.2023. Online ahead of print.

ABSTRACT

Attention and divisive normalization both contribute to making visual processing more efficient. Attention selectively increases the neural gain of relevant information in early visual cortex, resulting in stronger perceived salience for attended regions or features. Divisive normalization improves processing efficiency by suppressing responses to homogeneous inputs and highlighting salient boundaries, facilitating sparse coding of inputs. Theoretical and empirical research suggest a tight link between attention and normalization, wherein attending to a stimulus results in a release from normalization, thereby allowing for an increase in neural response gain. In the present study, we address whether attention alters the qualitative properties of normalization. Specifically, we examine how attention influences the feature-tuned nature of normalization, whereby suppression is stronger between visual stimuli whose orientation contents are similar, and weaker when the orientations are different. Ten human observers viewed stimuli that varied in orientation content while we acquired fMRI BOLD responses under two attentional states: attending towards or attending away from the stimulus. Our results indicate that attention does not alter the specificity of feature-tuned normalization. Instead, attention seems to enhance visuocortical responses evenly, regardless of the degree of orientation similarity within the stimulus. Since visuocortical responses exhibit adaptation to statistical regularities in natural scenes, we conclude that while attention can selectively increase the gain of responses to attended items, it does not appear to alter the ecologically relevant correspondence between orientation differences and strength of tuned normalization.

PMID:37706234 | DOI:10.1152/jn.00194.2023

J Neurophysiol. 2023 Sep 14. doi: 10.1152/jn.00069.2023. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite being studied for >50 years, the neurophysiological mechanisms underlying vibration(VIB)-induced kinesthetic illusions are still unclear. The aim of this study was to investigate how corticospinal excitability tested by transcranial magnetic stimulation (TMS) is modulated during VIB-induced illusions.

METHODS: Twenty healthy adults received vibration over wrist flexor muscles (80 Hz, 1 mm, 10 seconds). TMS was applied over the primary motor cortex representation of wrist extensors at 120% of resting motor threshold in four random conditions (10 trials/condition) : baseline (without VIB), 1s, 5s and 10s after VIB onset. Means of motor evoked potentiels (MEP) amplitudes and latencies were calculated.

RESULTS: Statistical analysis found a significant effect of conditions (stimulation timings) on MEP amplitudes (p=0.035). Paired-comparisons demonstrated lower corticospinal excitability during VIB at 1s compared to 5s (p=0.025) and 10s (p=0.003), although none of them differed to baseline values.

DISCUSSION: Results suggest a time-specific modulation of corticospinal excitability in muscles antagonistic to those vibrated, i.e. muscles involved in the perceived movement. An early decrease of excitability was observed at 1s followed by a stabilization of values near baseline at subsequent time-points. At 1s, the illusion is not yet perceived or not strong enough to up-regulate corticospinal networks coherent with the proprioceptive input. Spinal mechanisms, as reciprocal inhibition, could also contribute to lower the corticospinal drive of non-vibrated muscles in short period before the illusion emerges.

CONCLUSION: Our results suggest that neuromodulatory effects of VIB are likely time-dependent, and that future work is needed to further investigate underlying mechanisms.

PMID:37706230 | DOI:10.1152/jn.00069.2023

Milbank Q. 2023 Sep 14. doi: 10.1111/1468-0009.12672. Online ahead of print.

ABSTRACT

Policy Points The increasing political polarization of states reached new heights during the COVID-19 pandemic, when response plans differed sharply across party lines. This study found that states with Republican governors and larger Republican majorities in legislatures experienced higher death rates during the COVID-19 pandemic-and in preceding years-but these associations often lost statistical significance after adjusting for the average income and health status of state populations and for the policy orientations of the states. Future research may help clarify whether the higher death rates in these states result from policy choices or have other explanations, such as the tendency of voters with lower incomes or poorer health to elect Republican candidates.

CONTEXT: Increasing polarization of states reached a high point during the COVID-19 pandemic, when the party affiliation of elected officials often predicted their policy response. The health consequences of these divisions are unclear. Prior studies compared mortality rates based on presidential voting patterns, but few considered the partisan orientation of state officials. This study examined whether the partisan orientation of governors or legislatures was associated with mortality outcomes during the COVID-19 pandemic.

METHODS: Data on deaths and the partisan orientation of governors and legislators were obtained from the Centers for Disease Control and Prevention and the National Conference of State Legislatures, respectively. Linear regression was used to measure the association between Republican representation (percentage of seats held) in legislatures and (1) age-adjusted, all-cause mortality rates (AAMRs) in 2015-2021 and (2) excess death rates during three phases of the COVID-19 pandemic, controlling for median household income, the prevalence of four risk factors (obesity, chronic obstructive pulmonary disease, heart attack, stroke), and state policy orientation. Associations between excess death rates and the governor’s party were also examined.

FINDINGS: States with Republican governors or greater Republican representation in legislatures experienced higher AAMRs during 2015-2021, lower excess death rates during Phase 1 of the COVID-19 pandemic (weeks ending March 28, 2020, through June 13, 2020), and higher excess death rates in Phases 2 and 3 (weeks ending June 20, 2020, through April 30, 2022; p < 0.05). Most associations lost statistical significance after adjustment for control variables.

CONCLUSIONS: Mortality was higher in states with Republican governors and greater Republican legislative representation before and during much of the pandemic. Observed associations could be explained by the adverse effects of policy choices, reverse causality (e.g., popularity of Republican candidates in states with lower socioeconomic and health status), or unmeasured factors that predominate in states with Republican leaders.

PMID:37706227 | DOI:10.1111/1468-0009.12672