Tag: nevin manimala

Adv Skin Wound Care. 2023 May 1;36(5):243-248. doi: 10.1097/01.ASW.0000922704.17906.26.

ABSTRACT

OBJECTIVE: Previous studies demonstrated that costs paid on behalf of Medicare recipients for diabetic foot ulcers and venous leg ulcers treated with cellular and/or tissue-based products (CTPs) varied in part based on the CTP chosen. This study extends previous work to determine how costs vary when paid by commercial insurance carriers.

METHODS: A retrospective matched-cohort intent-to-treat design was used to analyze commercial insurance claims data between January 2010 and June 2018. Study participants were matched using Charlson Comorbidity Index, age, sex, type of wound, and geographic location within the US. Patients treated with a bilayered living cell construct (BLCC), dermal skin substitute (DSS), or cryopreserved human skin (CHSA) were included.

RESULTS: Wound-related costs and number of CTP applications were significantly lower for CHSA relative to BLCC and DSS at all time intervals (60, 90, and 180 days and 1 year after first application of the CTP). Further, CHSA was associated with significantly fewer amputations at 1 year relative to DSS (14.9% vs 19.7%, P = .03).

CONCLUSIONS: There was a statistically significant reduction in cost of treating diabetic foot ulcers (BLCC, DSS, CHSA) and venous leg ulcers (BLCC, CHSA) with CHSA as compared with the other CTPs. These findings are attributed to fewer applications, lower wound care costs, and comparable or reduced incidence of amputation. These commercial insurance data are consistent with prior studies that examined Medicare expenditures.

PMID:37079787 | DOI:10.1097/01.ASW.0000922704.17906.26

J Pediatr Gastroenterol Nutr. 2023 Apr 21. doi: 10.1097/MPG.0000000000003793. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVE: Heterogeneity and chronicity of Crohn’s disease (CD) make prediction of outcomes difficult. To date, no longitudinal measure can quantify burden over a patient’s disease course, preventing assessment and integration into predictive modelling. Here, we aimed to demonstrate the feasibility of constructing a data driven, longitudinal disease burden score.

METHODS: Literature was reviewed for tools used in assessment of CD activity. Themes were identified to construct a paediatric CD morbidity index (PCD-MI). Scores were assigned to variables. Data were extracted automatically from the electronic patient records at Southampton Children’s Hospital, diagnosed from 2012 to 2019 (inclusive). PCD-MI scores were calculated, adjusted for duration of follow up and assessed for variation (ANOVA) and distribution (Kolmogorov-Smirnov).

RESULTS: Nineteen clinical/biological features across five themes were included in the PCD-MI including blood/faecal/radiological/endoscopic results, medication usage, surgery, growth parameters and extraintestinal manifestations. Maximal score was 100 after accounting for follow-up duration.PCD-MI was assessed in 66 patients, mean age 12.5 years. Following quality filtering, 9528 blood/faecal test results and 1309 growth measures were included. Mean PCD-MI score was 14.95 (range 2.2-32.5), data were normally distributed (p=0.2) with 25% of patients having a PCD-MI <10. There was no difference in the mean PCD-MI when split by year of diagnosis, F-statistic 1.625, p=0.147.

CONCLUSIONS: PCD-MI is a calculatable measure for a cohort of patients diagnosed over an 8-year period, integrating a wide-range of data with potential to determine high or low disease burden. Future iterations of the PCD-MI require refinement of included features, optimised scores and validation on external cohorts.

PMID:37079872 | DOI:10.1097/MPG.0000000000003793

Cancer Prev Res (Phila). 2023 Apr 21:CAPR-22-0506. doi: 10.1158/1940-6207.CAPR-22-0506. Online ahead of print.

ABSTRACT

Identifying risk factors for early onset colorectal cancer (EOCRC) could help reverse its rising incidence through risk factor reduction and/or early screening. We sought to identify EOCRC risk factors that could be used for decisions about early screening. Using electronic databases and medical record review, we compared male veterans aged 35-49 years diagnosed with sporadic EOCRC (2008-2015) matched 1:4 to clinic and colonoscopy controls without CRC, excluding those with established inflammatory bowel disease, high-risk polyposis and non-polyposis syndromes, prior bowel resection, and high-risk family history. We ascertained sociodemographic and lifestyle factors, family and personal medical history, physical measures, vital signs, medications, and laboratory values 6-18 months prior to case diagnosis. In the derivation cohort (75% of the total sample), univariate and multivariate logistic regression models were used to derive a full model and a more parsimonious model. Both models were tested using a validation cohort. Among 600 cases of sporadic EOCRC (mean [SD] age 45.2 [3.5] years; 66% White), 1200 primary care clinic controls (43.4 [4.2] years; 68% White), and 1200 colonoscopy controls (44.7 [3.8] years; 63% White), independent risk factors included age, cohabitation and employment status, BMI, comorbidity, CRC or other visceral cancer in a first- or second-degree relative; alcohol use; exercise; hyperlipidemia; use of statins, NSAIDs, and multivitamins. Validation c-statistics were 0.75-0.76 for the full model and 0.74-0.75 for the parsimonious model, respectively. These independent risk factors for EOCRC may identify veterans for whom CRC screening prior to age 45 or 50 years should be considered.

PMID:37079701 | DOI:10.1158/1940-6207.CAPR-22-0506

Pediatr Emerg Care. 2023 Apr 21. doi: 10.1097/PEC.0000000000002941. Online ahead of print.

ABSTRACT

OBJECTIVES: The use of intraosseous (IO) access is recommended in cardiac arrest when peripheral venous access is not accessible. Various methodologies exist that are used for teaching and learning about cannulation of the IO route both in education and in research. The purpose of the present study was to compare self-efficacy in the cannulation technique for IO access through different techniques.

METHODS: A randomized comparative study was conducted. A total of 118 nursing students participated. The participants were randomly distributed into 2 intervention groups: chicken bone and egg. A checklist was used for data collection to evaluate the IO cannulation technique in nursing students and another to analyze self-efficacy.

RESULTS: The average total score of self-efficacy for all participants was 8.84 (standard deviation (SD) = 0.98). No statistically significant differences were found when comparing the total self-efficacy score and the intervention group (U = 1604.500; z = -0.733; P = 0.463). No statistically significant differences were found between both groups for the average total score of the procedure (U = 6916.500; z = -0.939; P = 0.348). The egg group carried out the IO cannulation procedure in a significantly less amount of time (M = 126.88, SD = 82.18) than the chicken bone group (M = 183.77, SD = 108.28), finding statistically significant differences (U = 4983.500; z = -5.326; P < 0.001).

CONCLUSIONS: Using an egg to teach and learn about IO access could be considered a methodology that is equally effective as using a chicken bone, with the advantage of achieving IO access in a lesser amount of time.

PMID:37079583 | DOI:10.1097/PEC.0000000000002941

MMWR Morb Mortal Wkly Rep. 2023 Apr 21;72(16):437-444. doi: 10.15585/mmwr.mm7216a5.

ABSTRACT

In 2021, the CDC Director declared that racism is a serious threat to public health,* reflecting a growing awareness of racism as a cause of health inequities, health disparities, and disease. Racial and ethnic disparities in COVID-19-related hospitalization and death (1,2) illustrate the need to examine root causes, including experiences of discrimination. This report describes the association between reported experiences of discrimination in U.S. health care settings and COVID-19 vaccination status and intent to be vaccinated by race and ethnicity during April 22, 2021-November 26, 2022, based on the analysis of interview data collected from 1,154,347 respondents to the National Immunization Survey-Adult COVID Module (NIS-ACM). Overall, 3.5% of adults aged ≥18 years reported having worse health care experiences compared with persons of other races and ethnicities (i.e., they experienced discrimination), with significantly higher percentages reported by persons who identified as non-Hispanic Black or African American (Black) (10.7%), non-Hispanic American Indian or Alaska Native (AI/AN) (7.2%), non-Hispanic multiple or other race (multiple or other race) (6.7%), Hispanic or Latino (Hispanic) (4.5%), non-Hispanic Native Hawaiian or other Pacific Islander (NHOPI) (3.9%), and non-Hispanic Asian (Asian) (2.8%) than by non-Hispanic White (White) persons (1.6%). Unadjusted differences in prevalence of being unvaccinated against COVID-19 among respondents reporting worse health care experiences than persons of other races and ethnicities compared with those who reported that their health care experiences were the same as those of persons of other races and ethnicities were statistically significant overall (5.3) and for NHOPI (19.2), White (10.5), multiple or other race (5.7), Black (4.6), Asian (4.3), and Hispanic (2.6) adults. Findings were similar for vaccination intent. Eliminating inequitable experiences in health care settings might help reduce some disparities in receipt of a COVID-19 vaccine.

PMID:37079512 | DOI:10.15585/mmwr.mm7216a5

MMWR Morb Mortal Wkly Rep. 2023 Apr 21;72(16):431-436. doi: 10.15585/mmwr.mm7216a4.

ABSTRACT

Stroke is the fifth leading cause of death and a leading cause of long-term disability in the United States (1). Although stroke death rates have declined since the 1950s, age-adjusted rates remained higher among non-Hispanic Black or African American (Black) adults than among non-Hispanic White (White) adults (1,2). Despite intervention efforts to reduce racial disparities in stroke prevention and treatment through reducing stroke risk factors, increasing awareness of stroke symptoms, and improving access to treatment and care for stroke (1,3), Black adults were 45% more likely than were White adults to die from stroke in 2018.* In 2019, age-adjusted stroke death rates (AASDRs) (stroke deaths per 100,000 population) were 101.6 among Black adults and 69.1 among White adults aged ≥35 years. Stroke deaths increased during the early phase of the COVID-19 pandemic (March-August 2020), and minority populations experienced a disproportionate increase (4). The current study examined disparities in stroke mortality between Black and White adults before and during the COVID-19 pandemic. Analysts used National Vital Statistics System (NVSS) mortality data accessed via CDC WONDER^† to calculate AASDRs among Black and White adults aged ≥35 years prepandemic (2015-2019) and during the pandemic (2020-2021). Compared with that during the prepandemic period, the absolute difference in AASDR between Black and White adults during the pandemic was 21.7% higher (31.3 per 100,000 versus 38.0). During the pandemic period, an estimated 3,835 excess stroke deaths occurred among Black adults (9.4% more than expected) and 15,125 among White adults (6.9% more than expected). These findings underscore the importance of identifying the major factors contributing to the widened disparities; implementing prevention efforts, including the management and control of hypertension, high blood cholesterol, and diabetes; and developing tailored interventions to reduce disparities and advance health equity in stroke mortality between Black and White adults. Stroke is a serious medical condition that requires emergency care. Warning signs of a stroke include sudden face drooping, arm weakness, and speech difficulty. Immediate notification of Emergency Medical Services by calling 9-1-1 is critical upon recognition of stroke signs and symptoms.

PMID:37079483 | DOI:10.15585/mmwr.mm7216a4

MMWR Morb Mortal Wkly Rep. 2023 Apr 21;72(16):421-425. doi: 10.15585/mmwr.mm7216a2.

ABSTRACT

Non-Hispanic Asian (Asian) and non-Hispanic Native Hawaiian and Pacific Islander (NHPI) persons represent growing segments of the U.S. population (1). Epidemiologic cancer studies often aggregate Asian and NHPI persons (2,3); however, because Asian and NHPI persons are culturally, geographically, and linguistically diverse (2,4), subgroup analyses might provide insights into the distribution of health outcomes. To examine the frequency and percentage of new cancer cases among 25 Asian and NHPI subgroups, CDC analyzed the most current 2015-2019 U.S. Cancer Statistics data.* The distribution of new cancer cases among Asian and NHPI subgroups differed by sex, age, cancer type, and stage at diagnosis (for screening-detected cancers). The percentage of cases diagnosed among females ranged from 47.1% to 68.2% and among persons aged <40 years, ranged from 3.1% to 20.2%. Among the 25 subgroups, the most common cancer type varied. For example, although breast cancer was the most common in 18 subgroups, lung cancer was the most common cancer among Chamoru, Micronesian race not otherwise specified (NOS), and Vietnamese persons; colorectal cancer was the most common cancer among Cambodian, Hmong, Laotian, and Papua New Guinean persons. The frequency of late-stage cancer diagnoses among all subgroups ranged from 25.7% to 40.3% (breast), 38.1% to 61.1% (cervical), 52.4% to 64.7% (colorectal), and 70.0% to 78.5% (lung). Subgroup data illustrate health disparities among Asian and NHPI persons, which might be reduced through the design and implementation of culturally and linguistically responsive cancer prevention and control programs, including programs that address social determinants of health.

PMID:37079478 | DOI:10.15585/mmwr.mm7216a2

Oper Dent. 2023 Apr 20. doi: 10.2341/22-042-L. Online ahead of print.

ABSTRACT

BACKGROUND: The objective was to investigate the radiopacity of 11 commercial posterior restorative materials by establishing their mean gray values (MGVs) and comparing them with dental hard tissues.

METHODS AND MATERIALS: Five-disc specimens were prepared for each of the following materials: Cerasmart 270 CAD/CAM block A3LT (CS), Amalgam (A), Ketac Molar A3 (KM), Cention-N A2 (CN), G-aenial Universal Flo AO2 (GO2) and A2 (G2), Ever-X Flow Dentine (EXD) and Bulk (EXB) shades, Equia Forte HT Fil A2 (EF2) and A3 (EF3), and Equia Fil A3 (E3). Freshly extracted maxillary premolar teeth were used as a control. The MGVs of specimens and a 10-step aluminum stepwedge (Al) were measured with Adobe Photoshop. ANOVA and Dunnett T3 tests were used to assess the significance of the differences (α=0.05).

RESULTS: Statistically significant differences were revealed between some of the groups. Amalgam had the highest radiopacity. The radiopacity of dentin and CS were close to that of 1 mm Al. G2, KM, GO2, EXB, and EXD showed higher mean radiopacity than dentin. Enamel had a radiopacity equivalent to 2 mm Al. CN, EF2, and E3 had higher mean radiopacity than enamel.

CONCLUSIONS: All materials met the ISO requirements. Alkasite and reinforced glass ionomer restoratives demonstrated higher mean radiopacity than the posterior flowable composites. Material shades did not affect the radiopacity.

PMID:37079911 | DOI:10.2341/22-042-L

Pain. 2023 Apr 20. doi: 10.1097/j.pain.0000000000002915. Online ahead of print.

ABSTRACT

Behavioral pain management interventions are efficacious for reducing pain in patients with cancer. However, optimal dosing of behavioral pain interventions for pain reduction is unknown, and this hinders routine clinical use. A Sequential Multiple Assignment Randomized Trial (SMART) was used to evaluate whether varying doses of Pain Coping Skills Training (PCST) and response-based dose adaptation can improve pain management in women with breast cancer. Participants (N = 327) had stage I-IIIC breast cancer and a worst pain score of >5/10. Pain severity (a priori primary outcome) was assessed before initial randomization (1:1 allocation) to PCST-Full (5 sessions) or PCST-Brief (1 session) and 5 to 8 weeks later. Responders (>30% pain reduction) were rerandomized to a maintenance dose or no dose and nonresponders (<30% pain reduction) to an increased or maintenance dose. Pain severity was assessed again 5 to 8 weeks later (assessment 3) and 6 months later (assessment 4). As hypothesized, PCST-Full resulted in greater mean percent pain reduction than PCST-Brief (M [SD] = -28.5% [39.6%] vs M [SD]= -14.8% [71.8%]; P = 0.041). At assessment 3 after second dosing, all intervention sequences evidenced pain reduction from assessment 1 with no differences between sequences. At assessment 4, all sequences evidenced pain reduction from assessment 1 with differences between sequences (P = 0.027). Participants initially receiving PCST-Full had greater pain reduction at assessment 4 (P = 0.056). Varying PCST doses led to pain reduction over time. Intervention sequences demonstrating the most durable decreases in pain reduction included PCST-Full. Pain Coping Skills Training with intervention adjustment based on response can produce sustainable pain reduction.

PMID:37079854 | DOI:10.1097/j.pain.0000000000002915

Psychol Trauma. 2023 Apr 20. doi: 10.1037/tra0001501. Online ahead of print.

ABSTRACT

OBJECTIVE: The main goal of the present study was to examine the association between personal characteristics and public stigma toward posttraumatic stress disorder (PTSD) survivors.

METHOD: Two hundred and ninety (N = 290) Israeli participants completed a survey that included demographic, self-esteem, spirituality, well-being, and stigma questionnaires. Descriptive statistics, correlations, linear regressions, and structural-equation modeling were conducted in order to examine the study model and hypotheses.

RESULTS AND CONCLUSION: The study findings demonstrate that self-esteem is associated with higher levels of belief that mental-health professionals can provide effective treatment for PTSD survivors, that survivors can recover and maintain normal relationships, and that survivors are not inclined to neglect their appearance and feel comfortable and calm with PTSD survivors. Spirituality is associated with a belief in professionals’ ability to effectively treat PTSD and lower levels of belief that survivors are easily noticeable. Well-being is associated with a belief that survivors are careless with their hygiene and feel anxious around PTSD survivors. Muslim participants were more likely than Jewish participants to believe that survivors can fully recover, are careless with their hygiene, and that it is relatively easy to spot survivors. They were also more likely to feel anxious around survivors. Acquaintance with a PTSD survivor was associated with lower levels of belief that it would be difficult to maintain a relationship with a survivor and a stronger belief that survivors are relatively easy to spot. These findings make an important contribution to our understanding of the relationship between personal characteristics and the public stigmas attached to PTSD survivors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37079840 | DOI:10.1037/tra0001501