Tag: nevin manimala

Ann Ig. 2023 May 24. doi: 10.7416/ai.2023.2571. Online ahead of print.

ABSTRACT

BACKGROUND: Readmission after a first hospitalization is a common occurrence. It may be due to incomplete treatment, poor care for underlying problems or reflect bad coordination with health services at the time of discharge. The aim of this study was to identify the factors and classify the pathologies that expose elderly patients to erroneous access to the Emergency/Urgency Department (EUD).

STUDY DESIGN: Retrospective observational study.

MATERIALS AND METHODS: From January 2016 to December 2019 we studied patients who had at least one readmission to the EUD in the six months following discharge. All EUD accesses of the same patient that occurred for the problem treated during the previous hospitalization were identified. Data was provided by the University Hospital of Siena. Patients were stratified by age, gender, and municipality of residence. We used an ICD-9-CM coding system to describe health problems. Statistical analysis was carried out with Stata software.

RESULTS: We studied 1,230 patients (46.6% females) the mean age was 78.2 ± 14.3. Most of them, 721 (58.6%) were ≥80 years old, 334 (27.1%) were 65-79, 138 (11.2%) were 41-64, and only 37 (3.0%) were ≤40. Patients who lived in Municipality of Siena had a lower probability to return than to those living in other municipalities (OR 0.76; 95%CI: 0.62-0.93; p<0,05). The main causes of readmission for ≥65 years old were “symptoms, signs and ill-defined conditions” (18.3%), “respiratory diseases” (15.0%), “injury and poisoning” (14.1%), “cardiovascular diseases” (11.8%), “classification of factors influencing health status and contact with health services” (9.8%), “genitourinary diseases” (6.6%) and “digestive diseases (5.7%).

CONCLUSIONS: We observed that patients residing a greater distance from the hospital facilitates the risk of readmission. The factors that were exposed could be used to identify frequent users and initiate measures to reduce their access.

PMID:37219889 | DOI:10.7416/ai.2023.2571

Health Rep. 2023 May 17;34(5):3-14. doi: 10.25318/82-003-x202300500001-eng.

ABSTRACT

BACKGROUND: Research has identified an association between sleep and obesity in the general population. It is also important to examine this association in a military population.

DATA AND METHODS: Data from the 2019 Canadian Armed Forces Health Survey (CAFHS) were used to estimate the prevalence of sleep duration, sleep quality characteristics, overweight and obesity for Regular Force members. The relationship of sleep duration and sleep quality with obesity was assessed with multivariable logistic regression that controlled for sociodemographic, work and health characteristics.

RESULTS: Females were significantly more likely than males to report meeting recommended sleep duration (7 hours to less than 10 hours; 48.7% vs. 40.4%), trouble falling or staying asleep (32.3% vs. 23.5%), or that sleep was not refreshing (64.0% vs. 57.7%). Difficulty staying awake did not differ significantly between males and females (6.3% vs. 5.4%). Obesity, but not being overweight, was significantly more prevalent among those who had short (less than 6 hours) or borderline (6 hours to less than 7 hours) sleep duration, or poor sleep quality. Compared with recommended sleep duration, short sleep duration (adjusted odds ratio [AOR] 1.3; 95% confidence interval [CI]: 1.2 to 1.6) and borderline sleep duration (AOR 1.2; 95% CI: 1.1 to 1.4) were associated with obesity for males, but not females, in fully controlled models. Sleep quality indicators were not independently associated with obesity.

INTERPRETATION: This study adds to the body of evidence that identifies an association between sleep duration and obesity. The results emphasize the importance of sleep as one of the components of the Canadian Armed Forces Physical Performance Strategy.

PMID:37219888 | DOI:10.25318/82-003-x202300500001-eng

J Nurs Adm. 2023 Jun 1;53(6):331-336. doi: 10.1097/NNA.0000000000001295.

ABSTRACT

OBJECTIVE: This observational descriptive study was designed to measure the effect a new evidence-based design (EBD) hospital has on pediatric medication safety.

BACKGROUND: Medication safety is a priority for nurse leaders. Controlling system design by increasing the understanding of the impact human factors have could improve medication delivery.

METHODS: Medication administration data from 2 studies conducted at the same hospital, 1 at an older facility in 2015 and the other at a new EBD facility in 2019, were compared using a similar research design.

RESULTS: Results indicate that rates of distractions per 100 drug administrations were all statistically significant, favoring the 2015 data regardless of the EBD. No statistically significant differences were observed in error rates of any type when comparing the data collected in the older facility versus the newer EBD facility.

CONCLUSION: This study demonstrated that EBD alone does not ensure the absence of medication errors. By comparing 2 data sets, unanticipated associations were found that could impact safety. Despite the new facility’s contemporary design, distractions persisted that could inform nurse leaders in developing interventions to support a safer patient care environment using a human factors approach.

PMID:37219885 | DOI:10.1097/NNA.0000000000001295

J Clin Neuromuscul Dis. 2023 Jun 1;24(4):199-206. doi: 10.1097/CND.0000000000000421.

ABSTRACT

OBJECTIVES: To determine the relationship between the number of plasma exchanges and clinical outcome in patients experiencing myasthenic crisis.

METHODS: We retrospectively reviewed all episodes of myasthenia gravis exacerbation/crisis who received plasmapheresis in patients admitted to a single-center tertiary care referral center from July 2008 to July 2017. We performed statistical analyses to determine whether the increased number of plasma exchanges improves the primary outcome (hospital length of stay) and the secondary outcome (disposition to home, skilled nursing facility, long-term acute care hospital, or death).

RESULTS: There is neither clinically observable nor statistically significant improvement in length of stay or disposition on discharge in patients who received 6 or greater sessions of plasmapheresis.

CONCLUSIONS: This study provides class IV evidence that extending the number of plasma exchanges beyond 5 does not correlate with decreased hospital length of stay or improved discharge disposition in patients experiencing myasthenic crisis.

PMID:37219863 | DOI:10.1097/CND.0000000000000421

Vet Ital. 2022 Dec 31;58(3). doi: 10.12834/VetIt.2342.16499.1.

ABSTRACT

Bovine ephemeral fever (BEF) virus (BEFV) is an arthropod borne virus that causes bovine ephemeral fever or three‑day sickness in cattle and buffaloes. This is the first report on seroprevalence of BEF in cattle and buffaloes in Gujarat, India. Total of 92 animals, 78 cattle and 14 buffaloes from three regions (districts) of Gujarat state of India, were screened for the presence of anti‑BEF antibodies. A total of 27 out of 92 animals were found positive and overall seroprevalence detected was 29.34% (95% CI 20.0‑38.6%). A total of 19 out of 78 cattle and 8 out of 14 buffalo’s samples were found positive BEFV antibodies. Species‑wise seroprevalence in cattle and buffaloes was 24.35% (95% CI 14.8‑33.8%) and 57.1% (95% CI 31.2‑83.0%), respectively. There was a statistically significant (p < 0.05) species effect based on the seroprevalence. In cattle, location‑wise seroprevalence was observed to be 26.82% (95% CI 13.2‑40.3%) and 21.62% (95% CI 8.3‑34.8%) in Navsari and Banaskantha districts, respectively. The effect of location is not statistically significant (p < 0.05). Cytopathic effect of Vero cells was characterized by rounding, granulation of the cytoplasm within 48‑72 hrs of post infection. This was the first report demonstrating the presence of BEFV in Gujarat state.

PMID:37219833 | DOI:10.12834/VetIt.2342.16499.1

Vet Ital. 2022 Dec 31;58(3). doi: 10.12834/VetIt.2596.16323.2.

ABSTRACT

West Nile virus (WNV) is an emerging arbovirus which affects humans and horses. A cross sectional study was carried out on 106 local horses in Kaduna and 78 domestic chickens in Federal Capital Territory. A total of 184 sera were screened for West Nile virus anti Pr‑E antibodies using ID Screen® West Nile competitive enzyme linked immunosorbent assay. For the horses, an overall prevalence of 92.45% was recorded while domestic chickens had a preponderance of 7.69%. From our study, there was a statistical significant difference between the occurrences of WNV in stallions than mares with p < 0.05. Comparing the occurrence of West Nile virus between species, horses were more likely to be infected by West Nile virus than domestic chickens (OR 147). This is the first seroprevalence study investigating West Nile virus infection in domestic chickens in Nigeria. The presence of the antibodies indicates the widespread circulation and the potential risk of infection in humans and animals. In order to understand the epidemiology of West Nile virus infection in Nigeria, there is need for surveillance to be implemented in human and animal sectors.

PMID:37219829 | DOI:10.12834/VetIt.2596.16323.2

Methods Mol Biol. 2023 May 24. doi: 10.1007/7651_2023_489. Online ahead of print.

ABSTRACT

There is a growing need for single-cell level data analysis in correlation with the advancements of microscopy techniques. Morphology-based statistics gathered from individual cells are essential for detection and quantification of even subtle changes within the complex tissues, yet the information available from high-resolution imaging is oftentimes sub-optimally utilized due to the lack of proper computational analysis software. Here we present ShapeMetrics, a 3D cell segmentation pipeline that we have developed to identify, analyze, and quantify single cells in an image. This MATLAB-based script enables users to extract morphological parameters, such as ellipticity, longest axis, cell elongation, or the ratio between cell volume and surface area. We have specifically invested in creating a user-friendly pipeline, aimed for biologists with a limited computational background. Our pipeline is presented with detailed stepwise instructions, starting from the establishment of machine learning-based prediction files of immuno-labeled cell membranes followed by the application of 3D cell segmentation and parameter extraction script, leading to the morphometric analysis and spatial visualization of cell clusters defined by their morphometric features.

PMID:37219813 | DOI:10.1007/7651_2023_489

Int J Comput Assist Radiol Surg. 2023 May 23. doi: 10.1007/s11548-023-02929-8. Online ahead of print.

ABSTRACT

INTRODUCTION: The use of MRI scans for pre-operative surgical planning of forearm osteotomies provides additional information of joint cartilage and soft tissue structures and reduces radiation exposure in comparison with the use of CT scans. In this study, we investigated whether using 3D information obtained from MRI with and without cartilage information leads to a different outcome of pre-operative planning.

METHODS: Bilateral CT and MRI scans of the forearms of 10 adolescent and young adult patients with a unilateral bone deformation were acquired in a prospective study. The bones were segmented from CT and MRI, and cartilage only from MRI. The deformed bones were virtually reconstructed, by registering the joint ends to the healthy contralateral side. An optimal osteotomy plane was determined that minimized the distance between the resulting fragments. This process was performed in threefold: using the CT and MRI bone segmentations, and the MRI cartilage segmentations.

RESULTS: Comparison of bone segmentation from MRI and CT scan resulted in a 0.95 ± 0.02 Dice Similarity Coefficient and 0.42 ± 0.07 mm Mean Absolute Surface Distance. All realignment parameters showed excellent reliability across the different segmentations. However, the mean differences in translational realignment between CT and MRI bone segmentations (4.5 ± 2.1 mm) and between MRI bone and MRI bone and cartilage segmentations (2.8 ± 2.1 mm) were shown to be clinically and statistically significant. A significant positive correlation was found between the translational realignment and the relative amount of cartilage.

CONCLUSION: This study indicates that although bone realignment remained largely similar when using MRI with and without cartilage information compared to using CT, the small differences in segmentation could induce statistically and clinically significant differences in the osteotomy planning. We also showed that endochondral cartilage might be a non-negligible factor when planning osteotomies for young patients.

PMID:37219804 | DOI:10.1007/s11548-023-02929-8

Drugs Real World Outcomes. 2023 May 23. doi: 10.1007/s40801-023-00370-6. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with overactive bladder (OAB) experience sudden, intense urges to urinate, which may include urge urinary incontinence and nocturia. Pharmacotherapy includes β₃-adrenergic receptor agonists such as mirabegron; however, mirabegron contains a label warning for cytochrome P450 (CYP) 2D6 inhibition, making coadministration with CYP2D6 substrates require monitoring and dose adjustment to avoid unintended increases in substrate concentration.

OBJECTIVE: To understand the codispensing patterns of mirabegron among patients using ten predefined CYP2D6 substrates with and before mirabegron dispensing.

METHODS: This retrospective claims database analysis used the IQVIA PharMetrics^® Plus Database to assess codispensing of mirabegron with ten predefined CYP2D6 substrate groups identified on the basis of medications most frequently prescribed in the United States, those with high susceptibility to CYP2D6 inhibition, and those with evidence for exposure-related toxicity. Patients had to be ≥ 18 years old before initiation of the CYP2D6 substrate episode that overlapped with mirabegron. The cohort entry period was November 2012 to September 2019, and the overall study period was 1 January 2011 to 30 September 2019. Comparisons of patient profiles at dispensing were made between time periods with and before mirabegron use in the same patient. Descriptive statistics were used to assess the number of exposure episodes, total duration of exposure, and median duration of exposure of CYP2D6 substrate dispensing with and before mirabegron.

RESULTS: CYP2D6 substrate exposure periods totaling ≥ 9000 person-months were available before overlapping exposure to mirabegron for all ten CYP2D6 substrate cohorts. Median codispensing duration for chronically administered CYP2D6 substrates was 62 (interquartile range [IQR] 91) days for citalopram/escitalopram, 71 (105) days for duloxetine/venlafaxine, and 75 (115) days for metoprolol/carvedilol; median codispensing duration for acutely administered CYP2D6 substrates was 15 (33) days for tramadol and 9 (18) days for hydrocodone.

CONCLUSIONS: In this claims database analysis, the dispensing patterns of CYP2D6 substrates with mirabegron displayed frequent overlapping of exposure. Thus, a need exists to better understand the outcomes experienced by patients with OAB who are at increased risk for drug‒drug interactions when taking multiple CYP2D6 substrates concurrently with a CYP2D6 inhibitor.

PMID:37219800 | DOI:10.1007/s40801-023-00370-6

J Robot Surg. 2023 May 23. doi: 10.1007/s11701-023-01625-8. Online ahead of print.

ABSTRACT

While laparoscopic simulation-based training is a well-established component of general surgery training, no such requirement or standardized curriculum exists for robotic surgery. Furthermore, there is a lack of high-fidelity electrocautery simulation training exercises in the literature. Using Messick’s validity framework, we sought to determine the content, response process, internal content and construct validity of a novel inanimate tissue model that utilizes electrocautery for potential incorporation in such curricula. A multi-institutional, prospective study involving medical students (MS) and general surgery residents (PGY1-3) was conducted. Participants performed an exercise using a biotissue bowel model on the da Vinci Xi robotic console during which they created an enterotomy using electrocautery, followed by approximation with interrupted sutures. Participant performance was recorded and then scored by crowd-sourced assessors of technical skill, along with three of the authors. Construct validity was determined via difference in Global Evaluative Assessment of Robotic Skills (GEARS) score, time to completion, and total number of errors between the two cohorts. Upon completion of the exercise, participants were surveyed on their perception of the exercise and its impact on their robotic training to determine content validity. 31 participants were enrolled and separated into two cohorts: MS + PGY1 vs. PGY2-3. Time spent on the robotic trainer (0.8 vs. 8.13 h, p = 0.002), number of bedside robotic assists (5.7 vs. 14.8, p < 0.001), and number of robotic cases as primary surgeon (0.3 vs. 13.1, p < 0.001) were statistically significant between the two groups. Differences in GEARS scores (18.5 vs. 19.9, p = 0.001), time to completion (26.1 vs. 14.4 min, p < 0.001), and total errors (21.5 vs. 11.9, p = 0.018) between the groups were statistically significant as well. Of the 23 participants that completed the post-exercise survey, 87% and 91.3% reported improvement in robotic surgical ability and confidence, respectively. On a 10-point Likert scale, respondents rated the realism of the exercise 7.5, educational benefit 9.1, and effectiveness in teaching robotic skills 8.7. Controlling for the upfront investment of certain training materials, each exercise iteration cost ~ $30. This study confirmed the content, response process, internal structure and construct validity of a novel, high-fidelity and cost-effective inanimate tissue exercise which successfully incorporates electrocautery. Consideration should be given to its addition to robotic surgery training programs.

PMID:37219784 | DOI:10.1007/s11701-023-01625-8