Tag: nevin manimala

BMC Palliat Care. 2023 Apr 6;22(1):36. doi: 10.1186/s12904-023-01151-2.

ABSTRACT

BACKGROUND: The COVID-19 pandemic impacts on working routines and workload of palliative care (PC) teams but information is lacking how resource use and associated hospital costs for PC changed at patient-level during the pandemic. We aim to describe differences in patient characteristics, care processes and resource use in specialist PC (PC unit and PC advisory team) in a university hospital before and during the first pandemic year.

METHODS: Retrospective, cross-sectional study using routine data of all patients cared for in a PC unit and a PC advisory team during 10-12/2019 and 10-12/2020. Data included patient characteristics (age, sex, cancer/non-cancer, symptom/problem burden using Integrated Palliative Care Outcome Scale (IPOS)), information on care episode, and labour time calculated in care minutes. Cost calculation with combined top-down bottom-up approach with hospital’s cost data from 2019. Descriptive statistics and comparisons between groups using parametric and non-parametric tests.

RESULTS: Inclusion of 55/76 patient episodes in 2019/2020 from the PC unit and 135/120 episodes from the PC advisory team, respectively. IPOS scores were lower in 2020 (PCU: 2.0 points; PC advisory team: 3.0 points). The number of completed assessments differed considerably between years (PCU: episode beginning 30.9%/54.0% in 2019/2020; PC advisory team: 47.4%/40.0%). Care episodes were by one day shorter in 2020 in the PC advisory team. Only slight non-significant differences were observed regarding total minutes/day and patient (PCU: 150.0/141.1 min., PC advisory team: 54.2/66.9 min.). Staff minutes showed a significant decrease in minutes spent in direct contact with relatives (PCU: 13.9/7.3 min/day in 2019/2020, PC advisory team: 5.0/3.5 min/day). Costs per patient/day decreased significantly in 2020 compared to 2019 on the PCU (1075 Euro/944 Euro for 2019/2020) and increased significantly for the PC advisory team (161 Euro/200 Euro for 2019/2020). Overhead costs accounted for more than two thirds of total costs. Direct patient cost differed only slightly (PCU: 134.7 Euro/131.1 Euro in 2019/2020, PC advisory team: 54.4 Euro/57.3 Euro).

CONCLUSIONS: The pandemic partially impacted on daily work routines, especially on time spent with relatives and palliative care problem assessments. Care processes and quality of care might vary and have different outcomes during a crisis such as the COVID-19 pandemic. Direct costs per patient/day were comparable, regardless of the pandemic.

PMID:37024852 | DOI:10.1186/s12904-023-01151-2

BMC Pulm Med. 2023 Apr 6;23(1):111. doi: 10.1186/s12890-023-02402-x.

ABSTRACT

BACKGROUND: Eosinophilic airway inflammation caused by respiratory virus infection has been demonstrated in basic research; however, clinical investigations are lacking. To clarify the extent to which respiratory virus infection induces airway eosinophilic inflammation, we reviewed the results of bronchoalveolar lavage (BAL) and respiratory virus testing performed at our hospital.

METHODS: Among the BAL procedures performed at the University of the Ryukyu Hospital from August 2012 to September 2016, we collected cases of acute respiratory disease in which multiplex polymerase chain reaction (PCR) was used to search for respiratory viruses. The effect of respiratory virus detection on BAL eosinophil fraction was analyzed using statistical analysis. A case study was conducted on respiratory virus detection, which showed an elevated BAL eosinophil fraction.

RESULTS: A total of 95 cases were included in this study, of which 17 were PCR-positive. The most common respiratory virus detected was parainfluenza virus (eight cases). The PCR-positive group showed a higher BAL eosinophil fraction than the PCR-negative group (p = 0.030), and more cases had a BAL eosinophil fraction > 3% (p = 0.017). Multivariate analysis revealed that being PCR-positive was significantly associated with BAL eosinophil fraction > 1% and > 3%. There were nine PCR-positive cases with a BAL eosinophil fraction > 1%, of which two cases with parainfluenza virus infection had a marked elevation of BAL eosinophil fraction and were diagnosed with eosinophilic pneumonia.

CONCLUSIONS: Cases of viral infection of the lower respiratory tract showed an elevated BAL eosinophil fraction. The increase in eosinophil fraction due to respiratory virus infection was generally mild, whereas some cases showed marked elevation and were diagnosed with eosinophilic pneumonia. Respiratory virus infection is not a rare cause of elevated BAL eosinophil fraction and should be listed as a differential disease in the practice of eosinophilic pneumonia.

PMID:37024839 | DOI:10.1186/s12890-023-02402-x

BMC Infect Dis. 2023 Apr 6;23(1):202. doi: 10.1186/s12879-023-08196-x.

ABSTRACT

BACKGROUND: Serogroup A Neisseria meningitidis was the major cause of meningococcal meningitis epidemics in the African meningitis belt before 2010 when the monovalent meningococcal A conjugate vaccine (MenAfriVac) was introduced in the region. Therefore, this study aimed to establish the trends in N. meningitidis serogroups from 2016 to 2020 in Ghana’s meningitis belt.

METHODS: Polymerase chain reaction (PCR) confirmed laboratory results of suspected cases of cerebrospinal meningitis from January, 2016 to March, 2020 were obtained from the Tamale Public Health Laboratory. The data were subjected to trend analysis using Statistical Package for the Social Sciences version 25. Differences between discrete variables were analyzed using the Cochran-Armitage trend test.

RESULTS: Of the 2,426 suspected cases, 395 (16.3%) were confirmed positive for N. meningitidis using PCR. Serogroup X showed a significant upward trend (P < 0.01), and serogroup W showed a downward trend (P < 0.01). However, no significant trend was observed for any other serogroup.

CONCLUSION: This study showed the emergence of serogroup X, a non-vaccine type, as the predominant N. meningitidis serogroup in the wake of a declining serogroup W in Ghana’s meningitis belt.

PMID:37024833 | DOI:10.1186/s12879-023-08196-x

Obstet Gynecol. 2023 Apr 6. doi: 10.1097/AOG.0000000000005144. Online ahead of print.

ABSTRACT

OBJECTIVE: To measure variation in delivery-related severe maternal morbidity (SMM) among individuals with Medicaid insurance by state and by race and ethnicity across and within states.

METHODS: We conducted a pooled, cross-sectional analysis of the 2016-2018 TAF (Transformed Medicaid Statistical Information System Analytic Files). We measured overall and state-level rates of SMM without blood transfusion for all individuals with Medicaid insurance with live births in 49 states and Washington, DC. We also examined SMM rates among non-Hispanic Black and non-Hispanic White individuals with Medicaid insurance in a subgroup of 27 states (and Washington, DC). We generated unadjusted rates of composite SMM and the individual indicators of SMM that comprised the composite. Rate differences and rate ratios were calculated to compare SMM rates for non-Hispanic Black and non-Hispanic White individuals with Medicaid insurance.

RESULTS: The overall rate of SMM without blood transfusion was 146.2 (95% CI 145.1-147.3) per 10,000 deliveries (N=4,807,143). Rates of SMM ranged nearly threefold, from 80.3 (95% CI 71.4-89.2) per 10,000 deliveries in Utah to 210.4 (95% CI 184.6-236.1) per 10,000 deliveries in Washington, DC. Non-Hispanic Black individuals with Medicaid insurance (n=629,774) experienced a higher overall rate of SMM (212.3, 95% CI 208.7-215.9) compared with non-Hispanic White individuals with Medicaid insurance (n=1,051,459); (125.3, 95% CI 123.2-127.4) per 10,000 deliveries (rate difference 87.0 [95% CI 82.8-91.2]/10,000 deliveries; rate ratio 1.7 [95% CI 1.7-1.7]). The leading individual indicator of SMM among all individuals with Medicaid insurance was eclampsia, although the leading indicators varied across states and by race and ethnicity. Many states were concordant in leading indicators among the overall, non-Hispanic Black, and non-Hispanic White populations (ie, in Oklahoma sepsis was the leading indicator for all three). Most states, however, were discordant in leading indicators across the three groups (ie, in Texas eclampsia was the leading indicator overall, pulmonary edema or acute heart failure was the leading indicator among the non-Hispanic Black population, and sepsis was the leading indicator among the non-Hispanic White population).

CONCLUSION: Interventions aimed at reducing SMM and, ultimately, mortality among individuals with Medicaid insurance may benefit from the data generated from this study, which highlights states that have the greatest burden of SMM, the differences in rates among non-Hispanic Black populations compared with non-Hispanic White populations, and the leading indicators of SMM overall, by state, and by race and ethnicity.

PMID:37023459 | DOI:10.1097/AOG.0000000000005144

J Infect Dev Ctries. 2023 Mar 31;17(3):397-403. doi: 10.3855/jidc.16611.

ABSTRACT

INTRODUCTION: The region of Eastern Europe and Сentral Asia has a growing HIV epidemic. Kazakhstan is a country in Central Asia with an estimated 33,000 people living with HIV. The new HIV infections have increased by 29% since 2010. Evidence suggests that HIV testing strategies focused on social networks are effective methods to identify more people with undiagnosed HIV. We conducted a study to describe the optimized HIV case finding (OCF) intervention for people who inject drugs (PWID) and their partners in Kazakhstan.

METHODOLOGY: The OCF is based on recruitment of the extended risk social networks of HIV-positive PWID, using a two-step recruitment algorithm.

RESULTS: There were 5,983 PWIDs and their partners tested for HIV, of those 149 (2.5%) received HIV-positive test results and the majority 145 (97%) were newly identified HIV-positive. The characteristics which had a statistically significant positive association with HIV-positive test results included: age group 15-19 (OR 4.12, 95% CI 1.44-11.7); age group 20-24 (OR 1.97, 95% CI 1.03-3.8); age group 50+ (OR 2.45, 95% CI 1.48-4.1); male sex (OR 1.78; 95% CI 1.2-2.6), participants who have previously received harm reduction services (OR 1.48; 95% CI 1.0-2.2); partners from “other groups” (OR 2.31, 95% CI 1.3-4.2).

CONCLUSIONS: Low-threshold HIV testing and harm reduction services, like OCF using directly assisted self-testing and social network strategies are essential in reaching key populations with HIV prevention, increasing access to HIV testing and care.

PMID:37023438 | DOI:10.3855/jidc.16611

J Infect Dev Ctries. 2023 Mar 31;17(3):327-334. doi: 10.3855/jidc.17717.

ABSTRACT

INTRODUCTION: Severe coronavirus disease 2019 (COVID-19) is mainly precipitated by an uncontrolled inflammatory response and cytokine storm. Pro-inflammatory cytokines such as IL-6 and IL-8 levels were markedly increased in complicated cases. Genetic polymorphisms may have a role in this dysregulated expression during SARS-CoV-2 infection. Our aim was to assess the influence of IL-6 and IL-8 single nucleotide polymorphisms (SNPs) on COVID-19 outcomes.

METHODOLOGY: 240 subjects were involved in the study; 80 cases with severe COVID-19, 80 cases with mild COVID-19, and 80 healthy subjects. IL-6rs1800795(G/C) and IL-8 rs2227306(C/T) genotyping was performed using real-time polymerase chain reaction (PCR).

RESULTS: Ages ranged between 20-67 years in all groups. There was a statistically significant association between the male gender and severe COVID-19. A significantly higher expression of IL-6rs1800795GG and IL-8rs2227306CC genotypes was observed among patients with severe COVID-19 than other groups. At the allele level, IL-6rs1800795G and IL-8rs2227306C alleles were more frequent among patients with severe COVID-19 when compared with other groups. Haplotypes’ frequency clarified that the coexistence of IL-6 rs1800795G and IL-8rs2227306C alleles in the same person increased the risk of severe COVID-19 outcomes. Carriers of IL-6rs1800795C and IL-8 rs2227306T alleles are at lower risk of developing severe COVID-19. Multivariate logistic regression analysis showed that old age, male gender, IL-6 rs1800795CG+GG, and IL-8 rs2227306CT+CC genotypes could be independent risk factors for severe COVID-19 outcomes.

CONCLUSIONS: IL-6 rs1800795G and IL-8 rs2227306C alleles are significantly associated with severe COVID-19 outcomes, especially if they coexist. They may be used as prognostic markers for COVID-19.

PMID:37023437 | DOI:10.3855/jidc.17717

J Infect Dev Ctries. 2023 Mar 31;17(3):304-310. doi: 10.3855/jidc.16642.

ABSTRACT

INTRODUCTION: Remdesivir was the only antiviral used in the treatment of COVID-19 in the first wave of the COVID-19 pandemic, following the adaptive COVID-19 treatment trial-1 interim analysis report. However, its use in moderate to critical hospitalized COVID-19 patients continues to be controversial.

METHODOLOGY: In a cohort of 1,531 moderate to critical COVID-19 patients, we retrospectively performed a nested case-control study where 515 patients on Remdesivir were compared to 411 patients with no Remdesivir. Cases and controls were matched for age, sex and severity. The primary outcome was in-hospital mortality and secondary outcomes were duration of hospital stay, need for intensive care unit (ICU), progression to oxygen therapy, progression to non-invasive ventilation, progression to mechanical ventilation, and duration of ventilation.

RESULTS: Mean age of the cohort was 57.05 + 13.5 years. 75.92% were males. Overall, in-hospital mortality was 22.46% (n = 208). There was no statistically significant difference in all-cause mortality among cases and controls (20.78% vs. 24.57%, p = 0.17). Progression to non-invasive ventilation was lower in the Remdesivir group (13.6% vs 23.7%, p < 0.001), however progression to mechanical ventilation was higher in the Remdesivir group (11.3% vs 2.7%, p value < 0.001*). In a subgroup analysis of critically ill patients, the use of Remdesivir lowered mortality (OR 0.32 95% CI: 0.13 – 0.75).

CONCLUSIONS: Remdesivir did not decrease the in-hospital mortality in moderate to severe COVID-19 but decreased progression to non-invasive ventilation. Its mortality benefit in critically ill patients needs further evaluation. Remdesivir may be useful if given early in the treatment of patients with moderate COVID-19.

PMID:37023432 | DOI:10.3855/jidc.16642

J Infect Dev Ctries. 2023 Mar 31;17(3):345-352. doi: 10.3855/jidc.17319.

ABSTRACT

INTRODUCTION: Antibiotic overuse and misuse can cause serious health issues. These problems have contributed to a rise in bacterial resistance. Hence, our study aims to highlight the existing knowledge and attitudes toward antibiotic usage among the general public in Aden-Yemen.

METHODOLOGY: A cross-sectional descriptive study of knowledge, attitude, and practice of the general public was conducted in different areas of Aden city-Yemen. The study conveniently selected a sample of 400 general public working in different areas in Aden. Descriptive statistics were used for data analysis.

RESULTS: A total of 400 participants were involved in the study. Nearly 88.8% administered antibiotics in all cases of fever, 58.3% thought that antibiotics could cure infections caused by the virus, and 65.5% disagree that antibiotics should be stopped as soon as the complaint disappears. More than 77.5% thought that antibiotics in cases of the common cold are not necessary. However, 46.5% incorrectly thought that “early use of antibiotics in patients with cough, running nose, and sore throat would be cured quickly”. Concerning knowledge of antibiotic resistance, 81.5% correctly answered that “overuse of antibiotics increases the risk of resistance. Most respondents reported that physicians were their primary source of information regarding antibiotic use. The most noted among respondents was that 62.7% had antibiotics for treatment without prescription in the last six months.

CONCLUSIONS: Respondents have adequate knowledge and moderate attitude toward antibiotic use. However, self-medication was common practice among the general public of Aden. Therefore, they had a misunderstanding, misconception, and irrational use of antibiotics.

PMID:37023424 | DOI:10.3855/jidc.17319

J Med Internet Res. 2023 Apr 6;25:e43127. doi: 10.2196/43127.

ABSTRACT

BACKGROUND: High levels of seamless, bidirectional health information exchange continue to be broadly limited among provider groups despite the vast array of benefits that interoperability entails for patient care and the many persistent efforts across the health care ecosystem directed at advancing interoperability. As provider groups seek to act in their strategic best interests, they are often interoperable and exchange information in certain directions but not others, leading to the formation of asymmetries.

OBJECTIVE: We aimed to examine the correlation at the provider group level between the distinct directions of interoperability with regard to sending health information and receiving health information, to describe how this correlation varies across provider group types and provider group sizes, and to analyze the symmetries and asymmetries that arise in the exchange of patient health information across the health care ecosystem as a result.

METHODS: We used data from the Centers for Medicare & Medicaid Services (CMS), which included interoperability performance information for 2033 provider groups within the Quality Payment Program Merit-based Incentive Payment System and maintained distinct performance measures for sending health information and receiving health information. In addition to compiling descriptive statistics, we also conducted a cluster analysis to identify differences among provider groups-particularly with respect to symmetric versus asymmetric interoperability.

RESULTS: We found that the examined directions of interoperability-sending health information and receiving health information-have relatively low bivariate correlation (0.4147) with a significant number of observations exhibiting asymmetric interoperability (42.5%). Primary care providers are generally more likely to exchange information asymmetrically than specialty providers, being more inclined to receive health information than to send health information. Finally, we found that larger provider groups are significantly less likely to be bidirectionally interoperable than smaller groups, although both are asymmetrically interoperable at similar rates.

CONCLUSIONS: The adoption of interoperability by provider groups is more nuanced than traditionally considered and should not be seen as a binary determination (ie, to be interoperable or not). Asymmetric interoperability-and its pervasive presence among provider groups-reiterates how the manner in which provider groups exchange patient health information is a strategic choice and may pose similar implications and potential harms as the practice of information blocking has in the past. Differences in the operational paradigms among provider groups of varying types and sizes may explain their varying extents of health information exchange for sending and receiving health information. There continues to remain substantial room for improvement on the path to achieving a fully interoperable health care ecosystem, and future policy efforts directed at advancing interoperability should consider the practice of being asymmetrically interoperable among provider groups.

PMID:37023418 | DOI:10.2196/43127

JMIR Form Res. 2023 Apr 6;7:e40509. doi: 10.2196/40509.

ABSTRACT

BACKGROUND: The translation of mental health services into digital formats, deemed digital mental health interventions (DMHIs), has the potential to address long-standing obstacles to accessing care. However, DMHIs have barriers of their own that impact enrollment, adherence, and attrition in these programs. Unlike in traditional face-to-face therapy, there is a paucity of standardized and validated measures of barriers in DMHIs.

OBJECTIVE: In this study, we describe the preliminary development and evaluation of such a scale, the Digital Intervention Barriers Scale-7 (DIBS-7).

METHODS: Following an iterative QUAN → QUAL mixed methods approach, item generation was guided by qualitative analysis of feedback from participants (n=259) who completed a DMHI trial for anxiety and depression and identified barriers related to self-motivation, ease of use, acceptability, and comprehension of tasks. Item refinement was achieved through DMHI expert review. A final item pool was administered to 559 treatment completers (mean age 23.02 years; 438/559, 78.4% female; 374/559, 69.9% racially or ethnically minoritized). Exploratory factor analyses and confirmatory factor analyses were estimated to determine the psychometric properties of the measure. Finally, criterion-related validity was examined by estimating partial correlations between the DIBS-7 mean score and constructs related to treatment engagement in DMHIs.

RESULTS: Statistical analyses estimated a 7-item unidimensional scale with high internal consistency (α=.82, ω=0.89). Preliminary criterion-related validity was supported by significant partial correlations between the DIBS-7 mean score and treatment expectations (pr=-0.25), number of modules with activity (pr=-0.55), number of weekly check-ins (pr=-0.28), and treatment satisfaction (pr=-0.71).

CONCLUSIONS: Overall, these results provide preliminary support for the use of the DIBS-7 as a potentially useful short scale for clinicians and researchers interested in measuring an important variable often associated with treatment adherence and outcomes in DMHIs.

PMID:37023417 | DOI:10.2196/40509