Tag: nevin manimala

Br J Surg. 2022 Nov 24:znac415. doi: 10.1093/bjs/znac415. Online ahead of print.

ABSTRACT

BACKGROUND: High surgical volumes are attributed to improved quality of care, especially for extensive procedures. However, it remains unknown whether high-volume surgeons and hospitals have better results in gallstone surgery. The aim of this study was to investigate whether operative volume affects outcomes in cholecystectomies.

METHODS: A registry-based cohort study was performed, based on the Swedish Registry of Gallstone Surgery. Cholecystectomies from 2006 to 2019 were included. Annual volumes for the surgeon and hospital were retrieved. All procedures were categorized into volume-based quartiles, with the highest group as reference. Low volume was defined as fewer than 20 operations per surgeon per year and fewer than 211 cholecystectomies per hospital per year. Differences in outcomes were analysed separately for elective and acute procedures.

RESULTS: The analysis included 154 934 cholecystectomies. Of these, 101 221 (65.3 per cent) were elective and 53 713 (34.7 per cent) were acute procedures. Surgeons with low volumes had longer operating times (P < 0.001) and higher conversion rates in elective (OR 1.35; P = 0.023) and acute (OR 2.41; P < 0.001) operations. Low-volume surgeons also caused more bile duct injuries (OR 1.41; P = 0.033) and surgical complications (OR 1.15; P = 0.033) in elective surgery, but the results were not statistically significant for acute procedures. Low-volume hospitals had more bile duct injuries in both elective (OR 1.75; P = 0.002) and acute (OR 1.96; P = 0.003) operations, and a higher mortality rate after acute surgery (OR 2.53; P = 0.007).

CONCLUSION: This study has demonstrated that operative volumes influence outcomes in cholecystectomy. The results indicate that gallstone surgery should be performed by procedure-dedicated surgeons at hospitals with high volumes of this type of benign surgery.

PMID:36422988 | DOI:10.1093/bjs/znac415

Trop Med Infect Dis. 2022 Nov 17;7(11):385. doi: 10.3390/tropicalmed7110385.

ABSTRACT

Despite the enormous disruption of tuberculosis (TB) services reported globally, Bangladesh’s impact is not well documented. We aimed to assess the effect of the COVID-19 pandemic on the TB control program in Bangladesh from patients’ and service providers’ perspectives. We conducted a cross-sectional study from November-December 2021 at six conveniently selected Upazila Health Complexes (UHC) of the Dhaka division, Bangladesh. We conducted face-to-face interviews among 180 pulmonary TB service recipients and all TB service providers working in the selected UHC. We also reviewed TB registries from each UHC. All data were summarized using descriptive statistics tools. We found a 31% reduction in presumptive TB cases during 2021 compared to 2020. Other TB services, such as testing, were reduced by 16-36% during the same period. Service receivers reported a lack of transportation (95%), and a lack of adequate human resources (89%) as critical barriers to receiving and providing TB service, respectively. The findings of our study showed substantial interruption of TB service delivery during the COVID-19 pandemic, threatening the recent progress and pushback from achieving the 2035 End TB targets. Early mitigation of TB service delivery through adopting remote follow-ups using digital health technology and integrating COVID-19 and TB screening is essential for the continuity of essential TB services and achieving global TB targets.

PMID:36422935 | DOI:10.3390/tropicalmed7110385

Trop Med Infect Dis. 2022 Nov 12;7(11):373. doi: 10.3390/tropicalmed7110373.

ABSTRACT

Our study aims to describe the global distribution and dispersal patterns of the SARS-CoV-2 Omicron subvariants. Genomic surveillance data were extracted from the CoV-Spectrum platform, searching for BA.1*, BA.2*, BA.3*, BA.4*, and BA.5* variants by geographic region. BA.1* increased in November 2021 in South Africa, with a similar increase across all continents in early December 2021. BA.1* did not reach 100% dominance in all continents. The spread of BA.2*, first described in South Africa, differed greatly by geographic region, in contrast to BA.1*, which followed a similar global expansion, firstly occurring in Asia and subsequently in Africa, Europe, Oceania, and North and South America. BA.4* and BA.5* followed a different pattern, where BA.4* reached high proportions (maximum 60%) only in Africa. BA.5* is currently, by Mid-August 2022, the dominant strain, reaching almost 100% across Europe, which is the first continent aside from Africa to show increasing proportions, and Asia, the Americas, and Oceania are following. The emergence of new variants depends mostly on their selective advantage, translated as enhanced transmissibility and ability to invade people with existing immunity. Describing these patterns is useful for a better understanding of the epidemiology of the VOCs’ transmission and for generating hypotheses about the future of emerging variants.

PMID:36422924 | DOI:10.3390/tropicalmed7110373

Toxics. 2022 Nov 21;10(11):709. doi: 10.3390/toxics10110709.

ABSTRACT

Chemical poisoning is considered a common medico-social problem that, in addition to causing extensive morbidity and mortality, dominates the valuable health care service resources. Therefore, this study was conducted to explore the extent and frequency of chemical poisoning events among adults in Qassim region as well as the most common poisoning agents involved. A retrospective method of data collection was used employing medical record review for chemical poisoning cases that occurred in Qassim region during the 8-year period from January 2008 to December 2015. Data were collected using a standardized, validated data collection sheet. The study revealed that there is no steady trend (either decreasing or increasing) of the number of poisoning cases through time. There is a statistically significant association between the type of poisoning agent and gender (χ² = 14.3104, p &lt; 0.05). Moreover, there is a statistically significant association between the type of poisoning agent and period in years (χ² = 19.7565, p &lt; 0.05). It can be concluded that poisoning cases are distributed, to some extent, evenly between males and females, with no pattern through time. Educational programs are needed to raise public awareness about poisoning, especially among women.

PMID:36422917 | DOI:10.3390/toxics10110709

JMIR Public Health Surveill. 2022 Nov 24;8(11):e38182. doi: 10.2196/38182.

ABSTRACT

BACKGROUND: Multimorbidity has become a new challenge for medical systems and public health policy. Understanding the patterns of and associations among multimorbid conditions should be given priority. It may assist with the early detection of multimorbidity and thus improve quality of life in older adults.

OBJECTIVE: This study aims to comprehensively analyze and compare associations among multimorbid conditions by age and sex in a large number of middle-aged and older Chinese adults.

METHODS: Data from the home pages of inpatient medical records in the Shenzhen National Health Information Platform were evaluated. From January 1, 2017, to December 31, 2018, inpatients aged 50 years and older who had been diagnosed with at least one of 40 conditions were included in this study. Their demographic characteristics (age and sex) and inpatient diagnoses were extracted. Association rule mining, Chi-square tests, and decision tree analyses were combined to identify associations between multiple chronic conditions.

RESULTS: In total, 306,264 hospitalized cases with available information on related chronic conditions were included in this study. The prevalence of multimorbidity in the overall population was 76.46%. The combined results of the 3 analyses showed that, in patients aged 50 years to 64 years, lipoprotein metabolism disorder tended to be comorbid with multiple chronic conditions. Gout and lipoprotein metabolism disorder had the strongest association. Among patients aged 65 years or older, there were strong associations between cerebrovascular disease, heart disease, lipoprotein metabolism disorder, and peripheral vascular disease. The strongest associations were observed between senile cataract and glaucoma in men and women. In particular, the association between osteoporosis and malignant tumor was only observed in middle-aged and older men, while the association between anemia and chronic kidney disease was only observed in older women.

CONCLUSIONS: Multimorbidity was prevalent among middle-aged and older Chinese individuals. The results of this comprehensive analysis of 4 age-sex subgroups suggested that associations between particular conditions within the sex and age groups occurred more frequently than expected by random chance. This provides evidence for further research on disease clusters and for health care providers to develop different strategies based on age and sex to improve the early identification and treatment of multimorbidity.

PMID:36422885 | DOI:10.2196/38182

JMIR Serious Games. 2022 Nov 24;10(4):e38988. doi: 10.2196/38988.

ABSTRACT

BACKGROUND: There are limitations to conducting face-to-face classes following the recent COVID-19 pandemic. Web-based education is no longer a temporary form of teaching and learning during unusual events, such as pandemics, but has proven to be necessary to uphold in parallel with offline education in the future. Therefore, it is necessary to scientifically organize the priorities of a learner needs analysis by systematically and rationally investigating and analyzing the needs of learners for the development of virtual reality (VR) programs for core nursing skills (CNS).

OBJECTIVE: This study aimed to identify the priorities of learners’ needs for the development of VR programs for CNS using the Locus for Focus Model and Borich need assessment model.

METHODS: The participants included nursing students in South Korea who were in their second year or higher and had taken courses in fundamental nursing or CNS-related classes. The survey took place from May 20 to June 25, 2021. A total of 337 completed questionnaires were collected. Of these, 222 were used to conduct the final analysis. The self-report questionnaire consisted of 3 parts: perception of VR programs, demand for developing VR programs, and general characteristics. The general characteristics of the participants were analyzed using descriptive statistics. To determine the priority of the demand for developing VR programs for CNS, the Locus for Focus Model and the Borich priority formula were used.

RESULTS: In all, 7 skills were identified as being of the top priority for development, including intramuscular injection, intradermal injection, tube feeding, enema, postoperative care, supplying oxygen via nasal cannula, and endotracheal suction.

CONCLUSIONS: The analysis showed that nursing students generally needed and prioritized the development of VR programs for the nursing skills involving invasive procedures. The results of this study are intended to help in various practical education classes using VR programs in nursing departments, which are currently facing difficulties in teaching CNS on the web owing to COVID-19.

PMID:36422882 | DOI:10.2196/38988

JMIR Form Res. 2022 Nov 24;6(11):e37371. doi: 10.2196/37371.

ABSTRACT

BACKGROUND: Sleep disorders are a common occurrence in the general population. Yet today, it is clearly agreed that sleep disorders represent both a cancer risk factor and a biological consequence of the of the activation of the immuno-inflammatory system induced by cancer itself.

OBJECTIVE: The aim of this study was to assess the impact of sleep disorders on quality of life and identify the type of disorder and its causes in order to offer an adapted and personalized care plan.

METHODS: In a survey completed during the COVID-19 lockdown, 2000 hours of interviews were collected by remote consultations. During these calls, we administered a sleep questionnaire. This questionnaire was inspired by the STOP-BANG questionnaire and enquired about 6 items. The demographic details of each patient (eg, age and sex), the nature of the pathology, their past treatments, the ongoing cancer treatment, the mood, whether or not the patient is anxious or depressed, and the use of sleeping drug pills were analyzed. A univariate analysis was performed according to the presence or absence of fatigue. Chi-square test was applied to assess possible differences of variables’ link to sleep disturbance between patients complaining of fatigue and those without fatigue. The same test was then used to analyze patients on hormone therapy and those with no hormone therapy for 2 types of cancer-breast cancer and prostate cancer.

RESULTS: A total of 905 patients were prospectively included in this study. The average age was 66.7 (5 SD) years, and 606 (67%) patients were women; 142 patients declared being overweight. Breast cancer was the most frequently reported cancer. Nocturnal awakening was reported by 70% (n=633), fatigue by 50% (n=452), difficulty falling asleep by 38% (n=343), snoring reported by an independent observer in 38% (n=343), and apnea reported by an independent observer in 9% (n=81) of the patients. The univariate analysis showed that the feeling of tiredness was significantly greater in patients reporting difficulty falling asleep (P≥.99), pain (P<.001), and frequent awakening (P<.001), as well as in patients who were not receiving cancer treatment (P<.001). The univariate analysis showed that patients who were receiving breast cancer treatment and were under hormone therapy reported difficulty falling asleep (P=.04) and pain (P=.05). In a univariate analysis of patients treated for prostate cancer, being overweight was the only factor reported that had a statistically significant value.

CONCLUSIONS: Our preliminary data support and are consistent with data in the literature regarding the importance of sleep disorders in oncology. This justifies the usefulness of a diagnosis and early treatment of sleep disorders in patients with cancer. The Rafael Institute sleep observatory will enable patients to be identified and treated.

PMID:36422866 | DOI:10.2196/37371

Curr Psychiatry Rep. 2022 Nov 24. doi: 10.1007/s11920-022-01396-3. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: Traditional conceptualizations of both nonsuicidal self-injury (NSSI) and borderline personality disorder (BPD) typically rely on static and unidirectional, linear associations between key biopsychosocial vulnerabilities. Instead, we argue that utilizing a complex dynamic systems view of NSSI and BPD will advance the field, as such conceptual models allow for analysis of bottom-up effects for key vulnerabilities on disorder and behavior emergence, as well as top-down effects of the emergent disorder on underlying vulnerabilities.

RECENT FINDINGS: Following the presentation of a novel framework highlighting momentary and developmental dynamics, we explore several advances in the field that exhibit key dynamic qualities or inform dynamic conceptualizations of NSSI and BPD. At the momentary dynamic level, several advances are being made with multimethod and repeated assessment approaches, as well as advanced bidirectional and complex modeling procedures. Additional progress is being made at the developmental dynamic level, although several questions have arisen regarding the problem of onset and subsequent trajectory, particularly with issues such as pain perception and the interplay between interpersonal, emotional, and behavioral symptoms before and after treatment. Self-injury and BPD both exhibit substantial momentary and developmental dynamics in underlying vulnerabilities, including potential variance in momentary dynamics as a function of psychopathological developmental stage (e.g., onset versus maintenance versus recovery). Recent work has highlighted the necessity of utilizing multimodal research to encapsulate a holistic view of the interplay of several vulnerability factors, the developmental importance of assessment timing, and the need to examine the dynamic interplay between affect, behavior, and interpersonal experiences in BPD and/or NSSI. Research also indicated substantial variation in key vulnerability factors at both between- and within-person levels, highlighting the utility of harnessing statistical models that allow for the simultaneous incorporation of numerous variables at both levels and across several time points. As such, by using a complex dynamic systems conceptualization, we can begin to better understand integrated connections between key vulnerabilities, how they collectively interact in the short term, and how changes in the dynamic interplay between vulnerabilities may arise over the long term and with successful treatment.

PMID:36422833 | DOI:10.1007/s11920-022-01396-3

Adv Ther. 2022 Nov 24. doi: 10.1007/s12325-022-02352-6. Online ahead of print.

ABSTRACT

INTRODUCTION: The history of levothyroxine has been linked to advances in the treatment of thyroid disease and to date it is the standard therapy for the treatment of hypothyroidism. Bioequivalence studies are the most widely used method to demonstrate interchangeability, although controversy persists regarding the best design for this molecule declared as a narrow therapeutic index product in many countries. This study aimed to evaluate the pharmacokinetic profile of two formulations of levothyroxine to determine bioequivalence between them.

METHODS: This two-period, randomized, crossover, blind study was conducted in 80 healthy volunteers, of both sexes, using a single levothyroxine dose of 600 μg with a washout period of 42 days. Blood sampling was performed at – 30 min, – 15 min, and 0 h pre-dose and 30 min, 1, 1.5, 2, 2.5, 3, 4, 6, 8, 10, 12, 16, 24, and 48 h post-dose.

RESULTS: A total of 78 subjects successfully completed both periods. There were no serious adverse events during the study and both formulations were well tolerated. Baseline correction of serum levothyroxine concentrations was performed before statistical analysis. The mean maximum plasma concentration of the test product (Levotiroxina MK^®) was 57.49 ng/mL while for the reference product it reached 59.32 ng/mL. Importantly, both test and reference formulations reached maximum concentrations in plasma at about the same time. The areas under the pharmacokinetic curves with the test product showed AUC_0-t of 1407.1 ng h/mL and the reference product 1394.3 ng h/mL. The bioequivalence statistical analysis showed that the 90% confidence interval (CI_90%) of the ratio of test over reference formulation was within the bioequivalence margins of 90-111%. For C_max, the test/reference ratio was 96.2% with CI_90% of 91.6-100.9%, and for AUC_0-t the test/reference ratio was 99.9 with CI_90% of 93.3-107.0%.

CONCLUSIONS: Both formulations have the same pharmacokinetic profile and are bioequivalent in the narrow therapeutic index required by some health authorities.

PMID:36422808 | DOI:10.1007/s12325-022-02352-6

J Immigr Minor Health. 2022 Nov 24. doi: 10.1007/s10903-022-01430-9. Online ahead of print.

ABSTRACT

Associations between household social needs, acculturation, and emotional health remain understudied, particularly among Latinx mothers. We analyzed baseline survey data from 455 Latinx mothers in a previous study. Using multinomial regression, we examined whether emotional problems and perceived stress were associated with household social needs and acculturation. Almost half the sample reported four or more household social needs. Social needs cumulatively and independently predicted increased odds of frequent emotional problems or perceived stress. Lower acculturation predicted lower odds of frequent emotional problems. There is increased risk for emotional problems and stress in low-income Latinx mothers who experience high social need. Integrated social service and mental health care models may be one way to improve health outcomes. More research is needed to understand how clinical settings can leverage unique cultural protective factors to address the social and emotional health needs of Latinx mothers.

PMID:36422792 | DOI:10.1007/s10903-022-01430-9