Tag: nevin manimala

J Dent Hyg. 2023 Jun;97(3):28-40.

ABSTRACT

Purpose Patient and person-centered care are often used interchangeably. The abbreviation PCC is used in this paper in instances where patient/person centered care reflects the definition of person-centeredness. The purpose of this study was to assess how PCC is taught and evaluated in entry-level dental hygiene education programs to prepare graduates for future collaborations with oher health care pprofessionals in a wide range of practice settings.Methods A cross-sectional study was conducted using a 10-item survey emailed to directors of 325 accredited, entry-level dental hygiene education programs in the United States in December 2021. Descriptive statistics were calculated for all variables. Associations with curriculum settings, teaching, and evaluation methods for PCC, according to program degrees granted, were tested with Chi-square and Fisher’s Exact tests.Results The response rate was 23% (n=75). Seventy percent offered an associate degree (AS) and 29% offered a baccalareate degree (BS); 42% reported more than half of their curriculum is allocated to teaching PCC. Didactic lectures (100%), case presentations (97%), and clinical instruction (97%) were the most common methods used for teaching PCC. Baccalaureate programs used external rotations more than associate programs for teaching and evaluation of PCC (84.2% vs. 45.5%; p<0.01). The most common PCC terms used in Quality Assurance Plans included providing individualized care (99%) and delivering evidence-based care (91%). Ninety-three percent strongly agree-agree that teaching PCC prepares graduates for working in different settings (e.g., schools, nursing homes, etc.), and 82% strongly agree-agree that PCC prepares graduates to work with a variety of providers.Conclusion The allocation of curricula time for PCC varied widely across respondents. Conversely, the majority felt their graduates were well-prepared to work in different settings where both PCC and IPP are likely to be practiced. This study serves as a baseline for further analysis of how dental hygiene education is preparing graduates for future practice settings.

PMID:37280102

J Natl Cancer Inst. 2023 Jun 6:djad107. doi: 10.1093/jnci/djad107. Online ahead of print.

ABSTRACT

BACKGROUND: The patterns and determinants of long-term income among adolescent and young adult (AYA) cancer survivors, and the differences compared to peers, have not yet been fully explored. This study investigated the long-term effects of cancer on the income of AYA cancer survivors.

METHODS: The Netherlands Cancer Registry identified all AYA cancer patients (18-39 years) diagnosed in 2013 and alive 5 years post diagnosis. Clinical data of the selected AYA patients were linked to individual, administrative real-world labor market data of Statistics Netherlands. The control group consisted of a random sample of individuals of the same age, sex and migration background without cancer. Data on 2,434 AYA cancer patients and 9,736 controls were collected annually from 2011 until 2019. Changes in income level were measured and compared with the control group using difference-in-difference regression models.

RESULTS: AYA cancer survivors experience, on average, an 8.5% decrease in annual earnings, relative to the control population. The effects are statistically significant and permanent; (p < 0.01). Younger AYAs (those aged 18-25 years 15.5% income reduction), married cancer survivors (12.3%), females (11.6%), those diagnosed with stage IV disease (38.1%) and central nervous system (CNS; 15.7%) cancer patients experienced the largest decline in income, on average, relative to controls, all else constant.

CONCLUSION: Although dependent on the sociodemographic and clinical characteristics, a cancer diagnosis at AYA age has significant implications on the income of cancer patients. Awareness of vulnerable groups and the development of policies to mitigate the financial impact of cancer are critical.

PMID:37280086 | DOI:10.1093/jnci/djad107

Respir Care. 2023 Jun 6:respcare.10534. doi: 10.4187/respcare.10534. Online ahead of print.

ABSTRACT

BACKGROUND: Inhaled corticosteroids (ICSs) are a fundamental pillar of most regimens for long-term control of persistent asthma. Poor adherence to ICS medication is a common problem in the asthma population that can lead to poor asthma control. We hypothesized that conducting a follow-up telephone call after general pediatric clinic visits for asthma would improve refill persistence.

METHODS: We conducted a prospective cohort analysis of pediatric and young adult subjects followed in our pediatric primary care clinic for asthma on ICS medication found to have poor ICS refill persistence. This cohort received a follow-up telephone outreach call 5-8 weeks after the clinic visit. The primary outcome measure was refill persistence with regard to ICS therapy.

RESULTS: There were 289 subjects who met the inclusion criteria and did not meet any exclusion criteria for the study (n = 131 in the primary cohort, n = 158 in the post-COVID cohort). The mean ICS refill persistence increased significantly for subjects in the primary cohort (39.4 ± 30.8% post intervention vs 32.4 ± 19.7% pre intervention) (P = .02) but not in the post-COVID cohort (36.4 ± 25.6% post intervention vs 38.9 ± 21.0% pre intervention) (P = .26). There was not a statistically significant change in hospitalizations after the intervention in either the primary or the post-COVID cohorts (P = .08 and .07, respectively). Systemic corticosteroid courses and emergency department visits decreased significantly post intervention (P = .01 and P = .004, respectively) in the primary group but not in the post-COVID group (P = .75 and P = .16, respectively).

CONCLUSIONS: These results suggest that telephone outreach after out-patient clinic visits for asthma may have short-term benefit in ICS refill persistence; however, the effect size was small.

PMID:37280076 | DOI:10.4187/respcare.10534

Eur J Cardiothorac Surg. 2023 Jun 6:ezad220. doi: 10.1093/ejcts/ezad220. Online ahead of print.

ABSTRACT

OBJECTIVES: (i) To monitor cerebral blood flow velocity (CBFv) throughout aortic arch repair surgery and during recovery period in paediatric intensive care. (ii) To examine the relationship between near infrared spectroscopy (NIRS) and transcranial doppler ultrasound (TCD) during cardiac surgery. (iii) Examine CBFv in patients cooled to 20 °C and 25 °C.

METHODS: During aortic arch repair and after surgery, TCD was monitored in 24 neonates, alongside NIRS, blood pH, pO2, pCO2, HCO3, lactate, Hb, Htc (%) and temperature (core and rectal). General linear models were used to examine differences over time and cooling temperature. Repeated measured correlation (rmcor) were used to determine relationship between NIRS and TCD.

RESULTS: CBFv changed during arch repair procedure (main effect of time: p = 0.001). During cooling phase, CBFv increased by 10.0 cm/s (5.97 cm/s, 17.7 cm/s) compared to normothermic (p = 0.019). Once recovering in PICU, CBFv had increased from the preoperative measurement by 6.2 cm/s (0.21, 13.4; p = 0.045). CBFv changes were similar between patients cooled to 20 °C and 25 °C (main effect of temperature: p = 0.22). Repeated measures correlation identified a statistically significant but weak positive correlation between CBFv and NIRS (r = 0.25, p = <0.001).

CONCLUSIONS: Our data suggested that CBFv changed throughout aortic arch repair and was higher during cooling period. A weak relationship was found between NIRS and TCD. Overall, these findings could provide clinicians with information on how to optimise long-term cerebrovascular health.

PMID:37280071 | DOI:10.1093/ejcts/ezad220

J Clin Pathol. 2023 Jun 6:jcp-2023-208759. doi: 10.1136/jcp-2023-208759. Online ahead of print.

ABSTRACT

Aims To assess if ambient temperature-related effects on serum potassium levels impact clinical decision-making. Methods This study is an ecological time series consisiting of 1 218 453 adult patients with at least one ACE inhibitor (ACEI) prescription who participate in a large UK primary care dataset.Descriptive statistics and a quasi-Poisson regression model using time series data at regular time intervals (monthly) were undertaken to examine the association between potassium measurements and ACEI/potassium supplement prescriptions. RESULTS: It is noted that correlating with lower ambient temperature, serum potassium values follow a seasonal pattern; peaks in winter months and troughs in summer. During summer months, there are clear annual spikes in the number of potassium prescriptions suggesting a change in prescribing practice during periods of potentially spurious hyperkalaemia. The converse pattern is seen in the ACEI prescription proportion which spikes annually during the winter period with lower average ambient temperatures. Our time series modelling demonstrated that each one unit increase in potassium is associated with a 33% increased rate of ACEI prescriptions (risk ratio, RR 1.33; 95% CI 1.12 to 1.59) and 63% decreased rate of potassium supplements (RR 0.37; 95% CI 0.32 to 0.43). CONCLUSIONS: Our findings highlight the seasonal pattern in serum potassium and we observe a corresponding alteration in prescribing practice for potassium sensitive medications. These findings demonstrate the importance of educating clinicians on the presence of seasonal potassium variability in addition to standard measurement error, and its potential impact on their prescribing activity.

PMID:37280056 | DOI:10.1136/jcp-2023-208759

BMJ Open. 2023 Jun 6;13(6):e066744. doi: 10.1136/bmjopen-2022-066744.

ABSTRACT

OBJECTIVE: This study was aimed to determine the relationship between job stress and work-related quality of life (WRQoL) among emergency medical technicians (EMTs) in Lorestan province, Western Iran.

DESIGN: This was a cross-sectional study.

METHODS: Totally 430 EMTs who had been engaged in their respective units for more than 6 months from all emergency facilities in Lorestan province were selected using single stage cluster sampling method. Data were collected from April to July 2019 using two standard questionnaires: job stress (Health and Safety Executive (HSE)) and WRQoL. The OR with 95% CI was used to declare the statistical association (p≤0.05).

RESULTS: All participants were exclusively males, with a mean age of 32±6.87 years. The overall average score of job stress using the HSE scale was 2.69±0.43; while the overall quality of working life score was 2.48±1.01. The type of working shift was found to have a significant impact on the HSE-average score (F(3,417)=5.26, p=0.01); and on the WRQoL-average score (F(3,417)=6.89, p<0.01).

CONCLUSION: Two-thirds of EMTs working in governmental hospitals had job stress and a low quality of work-related life. Additionally, work shift was statistically significant associated with EMTs’ job stress and WRQoL.

PMID:37280030 | DOI:10.1136/bmjopen-2022-066744

BMJ Open. 2023 Jun 6;13(6):e069042. doi: 10.1136/bmjopen-2022-069042.

ABSTRACT

OBJECTIVE: Sedentary behaviour is associated with increased cancer risk. We aim to assess the associations of domain-specific and total sedentary behaviour with risk of endometrial cancer, with additional attention paid to potential differences in adjustment strategy for obesity and physical activity.

DESIGN: A systematic review and meta-analysis was conducted in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews (PRISMA) and Meta-Analyses and the Meta-analysis of Observational Studies in Epidemiology (MOOSE).

DATA SOURCES: PubMed, Embase and MEDLINE databases were searched up to 28 February 2023, supplemented by grey literature searches.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational human studies evaluating the association between sedentary behaviour and endometrial cancer.

DATA EXTRACTION AND SYNTHESIS: Two reviewers extracted data and conducted the quality assessment based on Newcastle-Ottawa Scale (NOS) independently. We used a random-effects model with inverse variance approach to pool the estimates. The extent of heterogeneity was quantified with the I ² statistics.

RESULTS: Sixteen studies were included in the systematic review. Fourteen studies involving 882 686 participants were included in the meta-analysis. The pooled relative risks (RRs) for high versus low level of overall sedentary behaviour was 1.28 (95% CI: 1.14 to 1.43; I² =34.8%). The increased risk regarding specific domains was 1.22 (95% CI: 1.09 to 1.37; I²=13.4%, n=10) for occupational domain, 1.34 (95% CI: 0.98 to 1.83; I²=53.7%, n=6) for leisure-time domain and 1.55 (95% CI: 1.27 to 1.89; I²=0.0%, n=2) for total sedentary behaviour. Larger pooled RRs were observed among studies with adjustment for physical activity and studies without adjustment for body mass index.

CONCLUSIONS: Higher levels of sedentary behaviour, total and occupational sedentary behaviour in particular, increase the risk of endometrial cancer. Future studies are needed to verify domain-specific associations based on objective quantification of sedentary behaviour, as well as the interaction of physical activity, adiposity and sedentary time on endometrial cancer.

PMID:37280028 | DOI:10.1136/bmjopen-2022-069042

BMJ Open. 2023 Jun 6;13(6):e066897. doi: 10.1136/bmjopen-2022-066897.

ABSTRACT

OBJECTIVES: To (1) understand what behaviours, beliefs, demographics and structural factors predict US adults’ intention to get a COVID-19 vaccination, (2) identify segments of the population (‘personas’) who share similar factors predicting vaccination intention, (3) create a ‘typing tool’ to predict which persona people belong to and (4) track changes in the distribution of personas over time and across the USA.

DESIGN: Three surveys: two on a probability-based household panel (NORC’s AmeriSpeak) and one on Facebook.

SETTING: The first two surveys were conducted in January 2021 and March 2021 when the COVID-19 vaccine had just been made available in the USA. The Facebook survey ran from May 2021 to February 2022.

PARTICIPANTS: All participants were aged 18+ and living in the USA.

OUTCOME MEASURES: In our predictive model, the outcome variable was self-reported vaccination intention (0-10 scale). In our typing tool model, the outcome variable was the five personas identified by our clustering algorithm.

RESULTS: Only 1% of variation in vaccination intention was explained by demographics, with about 70% explained by psychobehavioural factors. We identified five personas with distinct psychobehavioural profiles: COVID Sceptics (believe at least two COVID-19 conspiracy theories), System Distrusters (believe people of their race/ethnicity do not receive fair healthcare treatment), Cost Anxious (concerns about time and finances), Watchful (prefer to wait and see) and Enthusiasts (want to get vaccinated as soon as possible). The distribution of personas varies at the state level. Over time, we saw an increase in the proportion of personas who are less willing to get vaccinated.

CONCLUSIONS: Psychobehavioural segmentation allows us to identify why people are unvaccinated, not just who is unvaccinated. It can help practitioners tailor the right intervention to the right person at the right time to optimally influence behaviour.

PMID:37280023 | DOI:10.1136/bmjopen-2022-066897

BMJ Open. 2023 Jun 6;13(6):e073777. doi: 10.1136/bmjopen-2023-073777.

ABSTRACT

OBJECTIVES: The purpose of this study was to assess the clinical and economic impact of adverse drug reactions (ADRs) among patients admitted to the University of Gondar Comprehensive Specialized Hospital (UoGCSH).

DESIGN AND SETTING: A prospective nested case-control study was conducted at the UoGCSH among admitted adult patients with (cases) and without ADRs (controls) between May and October 2022.

PARTICIPANTS: All eligible adult patients admitted in the medical ward of the UoGCSH during the study period were included in this study.

MAIN OUTCOME MEASURES: The outcome variables were the clinical and economic outcomes. Length of hospital stay, visits to intensive care units (ICU) and in-hospital mortality were used to measure and compare clinical outcomes in patients with and without ADRs. The economic outcome was also assessed using direct medical-related costs and compared for the two groups. Paired samples t-test and McNemar tests were used to compare measurable outcomes between the two groups. A p value <0.05 at the 95% CI was considered statistically significant.

RESULTS: Out of a total of 214 eligible enrolled patients, 206 (103 with and 103 without ADRs) with a 96.3% response rate were included in the cohort. The length of hospital stay was much longer in patients with ADRs than without ADRs (19.8 vs 15.2 days, p<0.001). Similarly, ICU visits (11.2% vs 6.8%, p<0.001) and in-hospital mortality (4.4% vs 1.9%, p=0.012) were significantly higher in patients with ADRs compared with those without ADRs. Patients with ADRs were significantly charged with higher direct medical costs compared with those without ADRs (6237.2 vs 5256.3 Ethiopian birr; p<0.001).

CONCLUSION: This study concluded that ADRs had a significant impact on patients’ clinical and medical costs. Healthcare providers should strictly follow the patients to minimise ADR-related clinical and economic adverse outcomes.

PMID:37280017 | DOI:10.1136/bmjopen-2023-073777

J Pharm Pract. 2023 Jun 6:8971900231176430. doi: 10.1177/08971900231176430. Online ahead of print.

ABSTRACT

BACKGROUND: Cytomegalovirus (CMV) infection after abdominal organ transplantation is associated with increased morbidity and mortality. The use of valganciclovir for CMV prophylaxis is limited by drug-induced myelosuppression and potential emergence of resistance. Letermovir is approved for primary CMV prophylaxis in CMV seropositive allogeneic hematopoietic cell transplant recipients. However, it is increasingly used off-label for prophylaxis in solid organ transplant (SOT) recipients.

METHODS: Based on pharmacy records, we examined retrospectively the use of letermovir for CMV prophylaxis in abdominal transplant recipients initiated on therapy at our center from January 1, 2018 through October 15, 2020. Data were summarized using descriptive statistics.

RESULTS: Twelve episodes of letermovir prophylaxis occurred in ten patients. Four patients received primary and 6 patients received secondary prophylaxis during the study period, with 1 patient receiving letermovir secondary prophylaxis on 3 separate occasions. All patients receiving letermovir for primary prophylaxis had successful outcomes. However, letermovir secondary prophylaxis was unsuccessful in 5 of the 8 episodes (62.5%) due to breakthrough CMV DNAemia and/or disease. Only 1 patient discontinued therapy due to adverse effects.

CONCLUSION: Although letermovir was generally well tolerated, the high rate of failure when used as secondary prophylaxis was noteworthy. Additional controlled clinical trials assessing the safety and efficacy of letermovir prophylaxis in SOT recipients are warranted.

PMID:37280011 | DOI:10.1177/08971900231176430