Tag: nevin manimala

Neuropsychopharmacol Rep. 2023 Jul 11. doi: 10.1002/npr2.12367. Online ahead of print.

ABSTRACT

AIMS: The means of suicide vary, but in cases of impaired consciousness, it is often difficult to determine the initial treatment because it is not known whether a patient has overdosed or used pesticides or poisons. Therefore, we investigated the clinical characteristics of suicide by medication in patients with suicide attempts who were brought to the emergency department, especially the influence of age.

METHODS: Patients with suicide attempts were transported to the two hospitals. There were 96 males (38.4%) and 154 females (61.6%). The mean age was 43.5 ± 20 years, and both males and females were most often in their 20s. Data on sex, age, motive for suicide, means of suicide attempt, psychiatric diagnosis, length of hospital stay, and place of discharge were retrospectively analyzed.

RESULTS: The average age of the patients by means of suicide attempt was 40.5 years for “prescription drugs,” 30.2 years for “over-the-counter drugs,” and 63.5 years for “pesticide/poison.” For each means of suicide attempt, there was a significant difference in age among patients with suicide attempts using “prescription drugs,” “over-the-counter drugs” and “pesticides/poisons.” There was a statistical bias in the means and reasons for each suicide attempt.

CONCLUSION: The results showed that the age of patients who used over-the-counter medicines and pesticides and poisons varied significantly. It was thought that pesticide use should be considered first, especially when patients aged 50 years and over are brought to the hospital with impaired consciousness due to suicide attempts.

PMID:37433639 | DOI:10.1002/npr2.12367

BMJ. 2023 Jul 11;382:p1434. doi: 10.1136/bmj.p1434.

NO ABSTRACT

PMID:37433610 | DOI:10.1136/bmj.p1434

Nephrol Dial Transplant. 2023 Jul 11:gfad151. doi: 10.1093/ndt/gfad151. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with kidney replacement therapy (KRT) have been identified as a vulnerable group during the COVID-19 pandemic. This study reports the outcomes of COVID-19 in KRT patients in Sweden, a country where patients on KRT were prioritized early in the vaccination campaign.

METHODS: Patients with KRT between January 2019 and December 2021 in the Swedish Renal Registry were included. Data were linked to national healthcare registries. The primary outcome was monthly all-cause mortality over three-years follow-up. The secondary outcomes were monthly COVID-19 related deaths and hospitalizations. The results were compared with the general population using standardized mortality ratios. The difference in risk for COVID-19 related outcomes between dialysis and kidney transplant recipients was assessed in multivariable logistic regression models before and after vaccinations started.

RESULTS: On January 1, 2020, there were 4097 patients on dialysis (median age 70) and 5905 kidney transplant recipients (median age 58). Between March 2020 and February 2021, mean all-cause mortality rates increased by 10% (from 720 to 804 deaths) and 22% (from 158 to 206 deaths) in dialysis and kidney transplant recipients respectively compared with the same period 2019. After vaccinations started, all-cause mortality rates during the third wave (April 2021) returned to pre COVID-19 mortality rates among dialysis patients, while mortality rates remained increased among transplant recipients. Dialysis patients had a higher risk for COVID-19 hospitalizations and death before vaccinations started aOR 2.1 (95% CI 1.7-2.5), but a lower risk after vaccination, aOR 0.5 (95% CI 0.4-0.7) compared to kidney transplant recipients.

CONCLUSIONS: The COVID-19 pandemic in Sweden resulted in increased mortality and hospitalization rates among KRT patients. After vaccinations started, a distinct reduction in hospitalization and mortality rates was observed among dialysis patients, but not in kidney transplant recipients. Early and prioritized vaccinations of KRT patients in Sweden probably saved many lives.

PMID:37433606 | DOI:10.1093/ndt/gfad151

Radiol Technol. 2023 Jul;94(6):409-418.

ABSTRACT

PURPOSE: This study investigated several determinants of radiation safety culture among radiologic technologists to determine whether factors related to work shifts or workday length affect the perception of workplace radiation safety.

METHODS: The secondary analysis used de-identified data from 425 radiologic technologists collected with the Radiation Actions and Dimensions of Radiation Safety (RADS) questionnaire, a 35-item survey with valid and reliable psychometric properties. Respondents included radiologic technologists working in radiography, computed tomography (CT), mammography, and hospital radiology administration. Descriptive statistics were used to report RADS survey item outcomes, and analysis of variance (ANOVA) tests with Games-Howell post hoc tests were conducted to analyze the hypotheses.

RESULTS: Mean differences in perception of teamwork across imaging stakeholders (P < .001) and leadership actions (P = .001) were found across shift-length groups. In addition, mean differences in perception of teamwork across imaging stakeholders (P = .007) were found across work-shift groups.

DISCUSSION: Longer shifts (≥ 12 hours) and night shifts are related to a diminished perception of the importance of radiation safety among radiologic technologists. The study showed a significant effect of these shift factors on the perception of teamwork and leadership actions concerning radiation safety.

CONCLUSION: These results underscore the importance of leadership actions and messaging, teamwork-building, and in-service training on radiation safety for technologists who frequently work long, after-hours shifts.

PMID:37433604

Radiol Technol. 2023 Jul;94(6):397-408.

ABSTRACT

PURPOSE: To investigate the effects of patient-induced artifacts on the diagnostic performance of the COVID-19 Reporting and Data System (CO-RADS) and the computed tomography chest severity score (CT-SS).

METHODS: A single-center retrospective analysis of patients aged 18 years and older who were admitted to the authors’ hospital with laboratory-confirmed COVID-19 and underwent chest CT between July and November 2021 was conducted. Patients’ chest CT scans were examined by 3 radiologists for CT-SS and CO-RADS classifications. Patient-based artifacts, including metal artifacts, incomplete projection artifacts, motion artifacts, and insufficient inspiration, were identified by 3 readers who were unaware of each other. For statistical analysis, interreader agreement was investigated using Fleiss kappa () agreement analysis.

RESULTS: The study population included 549 patients with a median age of 66 years (IQR, 55-75 years), 321 (58.5%) of whom were men. According to the overall CO-RADS classification, the highest interreader agreement was in patients without CT artifacts ( = 0.924), while the lowest interreader agreement was in patients with motion artifacts ( = 0.613). For the CO-RADS 1 and 2 patient groups, insufficient inspiration decreased the interreader agreement most ( = 0.712 and = 0.250, respectively). For the CO-RADS 3, 4, and 5 patient groups, motion artifacts reduced the interreader agreement most ( = 0.464, = 0.453, and = 0.705, respectively). For total CT-SS, the highest kappa value was in patients without artifacts ( = 0.574), while the lowest kappa value was in patients with motion artifacts ( = 0.374).

DISCUSSION: The CT technologist can avoid patient-induced artifacts by placing patients carefully on the CT table, giving patients necessary instructions before CT acquisition, and selecting optimal scanning parameters. The authors are not aware of another study in the literature investigating the effects of patient-based artifacts on interreader agreement of CO-RADS classification and CT-SS for COVID-19.

CONCLUSION: CT artifacts degrade image quality and might lead to interreader disagreement of CO-RADS classification and CT-SS for patients with COVID-19.

PMID:37433603

BJU Int. 2023 Jul 11. doi: 10.1111/bju.16124. Online ahead of print.

ABSTRACT

BACKROUND: Kidney is an essential regulator of arterial blood pressure (BP) via the renin-angiotensin system. The impact of kidney surgery on BP is unclear.

OBJECTIVE: To evaluate the consequences of kidney surgery for renal tumor on BP.

DESIGN, SETTING AND PARTICIPANTS: In a multicenter prospective study, we evaluated 200 patients who underwent nephrectomy for renal tumor between 2018 and 2020 at 7 departments of the UROCCR network. All patients had localized cancer without pre-existing hypertension.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: BP was measured the week before nephrectomy, one month and six months after nephrectomy, according to the recommendations for home blood pressure measurement. Plasmatic renin was measured one week before surgery and 6 months after surgery. The primary endpoint was the occurrence of de novo hypertension (HTN). The secondary endpoint was a clinically significant increase in BP at six months defined by an increase in systolic and / or diastolic ABP ≥10 mmHg or if medical anti-hypertensive treatment was required RESULTS AND LIMITATIONS: BP and renin measurements were available for 182 (91%) and 136 (68%) patients, respectively. We excluded from the analysis 18 patients who had undeclared HTN detected on preoperative measurements. At six months, 31 (19.2%) patients had de novo HTN and 43 (26.3%) patients had a significant increase in their BP. The type of surgery was not associated with an increased risk of HTN (21.7% PN vs 15.7% RN; p=0.59). There was no difference between plasmatic renin levels before and after surgery (18.5 vs. 16, p=0.46). In multivariable analysis, age (O.R 1.07; CI-95 1.02-1.12; p=0.03) and BMI (O.R. 1.14; CI-95 1.03-1.26; p=0.01) were the only predictors of de novo HTN.

CONCLUSION: Surgical treatment of renal tumors is associated with significant changes in BP. These changes are not impacted by the type of surgery (PN vs RN).

PATIENT SUMMARY: In this study we evaluated blood pressure changes after surgery for renal tumors. We found that 19% of the patients developed de novo hypertension 6 months after surgery. We feel that patients who are scheduled to undergo kidney cancer surgery should be informed of these findings and have their blood pressure closely monitored after the operation.

PMID:37433580 | DOI:10.1111/bju.16124

Ann Rheum Dis. 2023 Jul 10:ard-2023-224416. doi: 10.1136/ard-2023-224416. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop evidence-based recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc).

METHODS: A task force comprising 7 rheumatologists, 15 other healthcare professionals and 3 patients was established. Following a systematic literature review performed to inform the recommendations, statements were formulated, discussed during online meetings and graded based on risk of bias assessment, level of evidence (LoE) and strength of recommendation (SoR; scale A-D, A comprising consistent LoE 1 studies, D comprising LoE 4 or inconsistent studies), following the European Alliance of Associations for Rheumatology standard operating procedure. Level of agreement (LoA; scale 0-10, 0 denoting complete disagreement, 10 denoting complete agreement) was determined for each statement through online voting.

RESULTS: Four overarching principles and 12 recommendations were developed. These concerned common and disease-specific aspects of non-pharmacological management. SoR ranged from A to D. The mean LoA with the overarching principles and recommendations ranged from 8.4 to 9.7. Briefly, non-pharmacological management of SLE and SSc should be tailored, person-centred and participatory. It is not intended to preclude but rather complement pharmacotherapy. Patients should be offered education and support for physical exercise, smoking cessation and avoidance of cold exposure. Photoprotection and psychosocial interventions are important for SLE patients, while mouth and hand exercises are important in SSc.

CONCLUSIONS: The recommendations will guide healthcare professionals and patients towards a holistic and personalised management of SLE and SSc. Research and educational agendas were developed to address needs towards a higher evidence level, enhancement of clinician-patient communication and improved outcomes.

PMID:37433575 | DOI:10.1136/ard-2023-224416

Biostatistics. 2023 Jul 11:kxad012. doi: 10.1093/biostatistics/kxad012. Online ahead of print.

ABSTRACT

Existing methods for fitting continuous time Markov models (CTMM) in the presence of covariates suffer from scalability issues due to high computational cost of matrix exponentials calculated for each observation. In this article, we propose an optimization technique for CTMM which uses a stochastic gradient descent algorithm combined with differentiation of the matrix exponential using a Padé approximation. This approach makes fitting large scale data feasible. We present two methods for computing standard errors, one novel approach using the Padé expansion and the other using power series expansion of the matrix exponential. Through simulations, we find improved performance relative to existing CTMM methods, and we demonstrate the method on the large-scale multiple sclerosis NO.MS data set.

PMID:37433567 | DOI:10.1093/biostatistics/kxad012

J Phys Act Health. 2023 Jul 11:1-9. doi: 10.1123/jpah.2022-0666. Online ahead of print.

ABSTRACT

BACKGROUND: There is little known about physical activity (PA) behaviors and its determinants in Cambodian adolescents, particularly with regard to the home and school settings. Therefore, we aimed to investigate these behaviors and determinants on their PA.

METHODS: The samples collected were from 168 high school students, aged 14-15 years. They were requested to complete the self-report PA questionnaire. Time spent in PA during weekday and weekend by school location and gender, and determinants on PA were analyzed. Differences in the mean values of the PA levels (in minutes) during weekday and the weekend between genders, and between school locations were analyzed using independent sample t tests. The percentage of students’ perceptions on the determinants were calculated. Chi-squared test was used to compare the differences in prevalence of students’ activities during their free time with respect to school location and gender.

RESULTS: The majority of the parents (86.9%-98.2%) demonstrated strong support for their children for academic work. Rural students spent an average time of moderate-to-vigorous PA greater than their counterparts from the urban areas during their weekend days (329.1 vs 239.2 min, respectively). Moderate to vigorous PA was likely to be higher during the weekends compared with weekdays among the boys (387.9 vs 361.4 min, respectively). Girls were more likely to spend their time on moderate to vigorous PA during the weekdays compared with the weekends (205.4 vs 180.5 min, respectively).

CONCLUSION: Consideration should be given to gender, school location, free time, and the environmental setting for the contextualization of more effective PA interventions with Cambodian youths.

PMID:37433521 | DOI:10.1123/jpah.2022-0666

J Natl Compr Canc Netw. 2023 Jul;21(7):715-723.e17. doi: 10.6004/jnccn.2023.7021.

ABSTRACT

BACKGROUND: Adolescents and young adults (AYAs) with advanced cancer often receive intensive end-of-life care, yet it is unclear if this is goal-concordant. Advance care planning (ACP) video tools may promote identification and communication of AYA preferences.

PATIENTS AND METHODS: We conducted a dual-site, 1:1 pilot randomized controlled trial of a novel video-based ACP tool in 50 dyads of AYA patients aged 18 to 39 years with advanced cancer and their caregivers. ACP readiness and knowledge, preferences for future care, and decisional conflict were obtained pre, post, and 3 months after the intervention and compared between groups.

RESULTS: Of the 50 AYA/caregiver dyads enrolled, 25 (50%) were randomized to the intervention. Participants primarily identified as female, white, and non-Hispanic. Most AYAs (76%) and caregivers (86%) identified their overall goal as life-prolonging preintervention; less identified this goal postintervention (42% AYAs; 52% caregivers). There was no significant difference in change in proportion of AYAs or caregivers choosing life-prolonging care, CPR, or ventilation between arms postintervention or at 3 months. The change in participant scores for ACP knowledge (AYAs and caregivers) and ACP readiness (AYAs) from preintervention to postintervention was greater in the video arm compared with the control arm; the difference in caregivers’ scores for decisional conflict from preintervention to postintervention in the video arm was statistically significant (15 vs 7; P=.005). Feedback from the video participants was overwhelmingly positive; of the 45 intervention participants who provided video feedback, 43 (96%) found the video helpful, 40 (89%) were comfortable viewing the video, and 42 (93%) indicated they would recommend the video to other patients facing similar decisions.

CONCLUSIONS: Most AYAs with advanced cancer and their caregivers preferred life-prolonging care in advanced illness, with fewer preferring this type of care postintervention. A brief video-based ACP tool was well-liked by participants and improved caregiver decisional certainty. Videos may be a useful tool to inform AYAs and caregivers about end-of-life care options and promote ACP discussions.

PMID:37433434 | DOI:10.6004/jnccn.2023.7021