Tag: nevin manimala

Clin J Oncol Nurs. 2022 Nov 18;26(6):651-658. doi: 10.1188/22.CJON.651-658.

ABSTRACT

BACKGROUND:  Children undergoing a hematopoietic stem cell transplantation (HSCT) are at a higher risk for malnutrition, which could be reduced by enteral nutrition (EN) support.

OBJECTIVES:  This study evaluated the safety and feasibility of implementing an EN pathway for children undergoing HSCT.

METHODS:  An evidence-based, standardized EN pathway was implemented for children undergoing HSCT. Parenteral nutrition and EN rates were compared among patients pre- and postimplementation, and t tests and chi-square tests were performed.

FINDINGS:  A larger proportion of patients received EN and had an increased number of EN days (8.3 versus 5.3 days) postimplementation, which was clinically significant but not statistically significant. Postimplementation, 15 patients required EN and parenteral nutrition. The EN pathway was safe, but had limited feasibility because of the difficulty of placing and maintaining the nasojejunal tube.

PMID:36413717 | DOI:10.1188/22.CJON.651-658

Am J Public Health. 2022 Nov 22:e1-e10. doi: 10.2105/AJPH.2022.307150. Online ahead of print.

ABSTRACT

Just-in-time adaptive interventions (JITAIs) represent an intervention design that adapts the provision and type of support over time to an individual’s changing status and contexts, intending to deliver the right support on the right occasion. As a novel strategy for delivering mobile health interventions, JITAIs have the potential to improve access to quality care in underserved communities and, thus, alleviate health disparities, a significant public health concern. Valid experimental designs and analysis methods are required to inform the development of JITAIs. Here, we briefly review the cutting-edge design of microrandomized trials (MRTs), covering both the classical MRT design and its outcome-adaptive counterpart. Associated statistical challenges related to the design and analysis of MRTs are also discussed. Two case studies are provided to illustrate the aforementioned concepts and designs throughout the article. We hope our work leads to better design and application of JITAIs, advancing public health research and practice. (Am J Public Health. Published online ahead of print November 22, 2022:e1-e10. https://doi.org/10.2105/AJPH.2022.307150).

PMID:36413704 | DOI:10.2105/AJPH.2022.307150

Arch Cardiol Mex. 2022;92(4):469-475. doi: 10.24875/ACM.21000348.

ABSTRACT

INTRODUCTION: Oxygen saturation and lactate are markers of tissue hypoxia; they are obtained from central venous and mixed venous sample of the pulmonary artery. The simultaneous behavior of these parameters in the postoperative period of cardiac surgery is unknown.

OBJECTIVE: To characterize the lactate and oxygen saturation of the venous-arterial circuit of the postoperative patient from cardiac surgery.

METHODS: Design: Analytical cross-sectional. In consecutive patients after cardiac surgery, serum lactate and oxygen saturation of the venous-arterial circuit were obtained. The variables were reported with median (25.75 percentiles). They were analyzed with Kruskal-Wallis ANOVA and respective adjustment, Spearman correlation, the descriptive Bland-Altman statistic and intraclass correlation coefficient (95% confidence interval). A p < 0.05 was considered significant.

RESULTS: 244 blood samples from 61 patients were studied. Women 30 (49%). (Oxygen saturation) [lactate] were: arterial 98 (95.3, 99.4%) and 1.7 (1.1, 2.1); peripheral venous 85 (75.4, 94%) and [1.9 (1.35, 2.3)]; central venous 68.8 (58.74, 70.2%) and 1.8 (1.3, 2.3); mixed central venous 66.8 (61.2, 73.1%) and 1.8 (1.3, 2.2), p < 0.05. The best intraclass correlation coefficient for oxygen saturation were from central vein to mixed central vein 0.856 (0.760,0.914); and lactate: 0.954 (0.923, 0.972).

CONCLUSIONS: The oxygen saturation differs in the venous-arterial circuit unlike lactate where they are similar. The best values of the intraclass correlation coefficient for lactate and oxygen saturation were those obtained in central vein and mixed central vein.

PMID:36413688 | DOI:10.24875/ACM.21000348

Am J Clin Oncol. 2022 Dec 1;45(12):534-536. doi: 10.1097/COC.0000000000000955. Epub 2022 Nov 22.

ABSTRACT

Novel toxicity metrics that account for all adverse event (AE) grades and the frequency of may enhance toxicity reporting in clinical trials. The Toxicity Index (TI) accounts for all AE grades and frequencies for categories of interest. We evaluate the feasibility of using the TI methodology in 2 prospective anal cancer trials and to evaluate whether more conformal radiation (using Intensity Modulated Radiation Therapy) results in improved toxicity as measured by the TI. Patients enrolled on NRG/RTOG 0529 or nonconformal RT enrolled on the 5-Fluorouracil/Mitomycin arm of NRG/RTOG 9811 were compared using the TI. Patients treated on NRG/RTOG 0529 had lower median TI compared with patients treated with nonconformal RT on NRG/RTOG 9811 for combined GI/GU/Heme/Derm events (3.935 vs 3.996, P=0.014). The TI methodology is a feasible method to assess all AEs of interest and may be useful as a composite metric for future efforts aimed at treatment de-escalation or escalation.

PMID:36413683 | DOI:10.1097/COC.0000000000000955

Am J Clin Oncol. 2022 Dec 1;45(12):501-505. doi: 10.1097/COC.0000000000000952. Epub 2022 Nov 14.

ABSTRACT

OBJECTIVES: The best fractionation for stereotactic body radiotherapy (SBRT) in renal cell carcinoma (RCC) metastases has not been well defined. In addition, the literature on outcomes using 5-fraction SBRT in the setting of osseous metastases has not been well reported.

MATERIALS AND METHODS: Thirty-nine patients with 69 RCC osseous metastases were treated using 5-fraction SBRT at a single institution using 2 dose-fractionation schemes. Overall survival and local-control (LC) outcomes of the 2 fractionation schemes were studied using Kaplan-Meier curves.

RESULTS: Of the 69 lesions included in the study, 20 were treated with 30 grays (Gy) in 5 fractions and 49 were treated with 40 Gy in 5 fractions. The median age of patients at diagnosis was 58.4 years. The 1-year LC rate for all treated lesions was 85.5% (59/69) with an LC of 90% (18/20) for lesions receiving 30 Gy and 83.7% (41/49) in lesions receiving 40 Gy. There was no statistically significant difference in 1-year LC rate between the 2 fractionation schemes (P-value, 0.553).

CONCLUSIONS: Patients with osseous RCC metastases undergoing 5 fractions of SBRT had favorable LC outcomes. There was no difference in survival or LC between the 40 Gy and 30 Gy treatment arms.

PMID:36413679 | DOI:10.1097/COC.0000000000000952

Dimens Crit Care Nurs. 2023 Jan-Feb 01;42(1):22-32. doi: 10.1097/DCC.0000000000000557.

ABSTRACT

BACKGROUND: Although the body of knowledge related to Cardiac Surgery Unit Advanced Life Support (CSU-ALS) guideline has grown over the last 10 years, there is no existing literature examining the impact of this training on patient mortality outcomes.

OBJECTIVES: This article describes one institution’s experience related to patient mortality outcomes following a rigorous training program following the CSU-ALS guideline. Because of the small numbers associated with cardiac arrests after cardiac surgery (0.7%-8%), statistical significance was not a goal.

METHODS: A quasi-experimental design was used to compare mortality outcomes before and after CSU-ALS training. One hundred percent of the staff were trained in the initial year, and 85% to 90% of the staff maintained competency in the following years. The author used 10 years of retrospective data to compare mortality rates 4 years before and 6 years after the intervention.

RESULTS: The retrospective data showed a decrease in the percentage of failure-to-rescue rate in the intervention group (control 16% vs intervention 2%). Fisher exact testing implies that the observed frequencies were not significantly different from the expected frequencies (P = .072 and P = .135). Because of the small sample size, statistical significance could not be established.

DISCUSSION: This institution experienced an extremely positive track record in outcomes despite its inability to prove a statistically significant correlation to the CSU-ALS training. The overall observed and self-reported confidence level of the staff during the study period was outside the project scope but deserves mention and further research.

PMID:36413642 | DOI:10.1097/DCC.0000000000000557

Europace. 2022 Nov 23:euac213. doi: 10.1093/europace/euac213. Online ahead of print.

ABSTRACT

AIMS: Three Tesla (T) magnetic resonance imaging (MRI) provides critical imaging information for many conditions. Owing to potential interactions of the magnetic field, it is largely withheld from patients with cardiac implantable electronic devices (CIEDs). Therefore, we assessed the safety of 3T MRI in patients with ‘3T MRI-conditional’ and ‘non-3T MRI-conditional’ CIEDs.

METHODS AND RESULTS: We performed a retrospective single-centre analysis of clinically indicated 3T MRI examinations in patients with conventional pacemakers, cardiac resynchronization devices, and implanted defibrillators from April 2020 to May 2022. All CIEDs were interrogated and programmed before and after scanning. Adverse events included all-cause death, arrhythmias, loss of capture, inappropriate anti-tachycardia therapies, electrical reset, and lead or generator failure during or shortly after MRI. Changes in signal amplitude and lead impedance were systematically assessed. Statistics included median and interquartile range. A total of 132 MRI examinations were performed on a 3T scanner in 97 patients. Thirty-five examinations were performed in patients with ‘non-3T MRI-conditional’ CIEDs. Twenty-six scans were performed in pacemaker-dependent patients. No adverse events occurred during or shortly after MRI. P-wave or R-wave reductions ≥ 50 and ≥ 25%, respectively, were noted after three (2.3%) scans, all in patients with ‘3T MRI-conditional’ CIEDs. Pacing and shock impedance changed by ± 30% in one case (0.7%). Battery voltage and stimulation thresholds did not relevantly change after MRI.

CONCLUSION: Pending verification in independent series, our data suggest that clinically indicated MRI scans at 3T field strength should not be withheld from patients with cardiac pacemakers or defibrillators.

PMID:36413601 | DOI:10.1093/europace/euac213

PLoS Comput Biol. 2022 Nov 22;18(11):e1010650. doi: 10.1371/journal.pcbi.1010650. eCollection 2022 Nov.

ABSTRACT

Network science has increasingly become central to the field of epidemiology and our ability to respond to infectious disease threats. However, many networks derived from modern datasets are not just large, but dense, with a high ratio of edges to nodes. This includes human mobility networks where most locations have a large number of links to many other locations. Simulating large-scale epidemics requires substantial computational resources and in many cases is practically infeasible. One way to reduce the computational cost of simulating epidemics on these networks is sparsification, where a representative subset of edges is selected based on some measure of their importance. We test several sparsification strategies, ranging from naive thresholding to random sampling of edges, on mobility data from the U.S. Following recent work in computer science, we find that the most accurate approach uses the effective resistances of edges, which prioritizes edges that are the only efficient way to travel between their endpoints. The resulting sparse network preserves many aspects of the behavior of an SIR model, including both global quantities, like the epidemic size, and local details of stochastic events, including the probability each node becomes infected and its distribution of arrival times. This holds even when the sparse network preserves fewer than 10% of the edges of the original network. In addition to its practical utility, this method helps illuminate which links of a weighted, undirected network are most important to disease spread.

PMID:36413581 | DOI:10.1371/journal.pcbi.1010650

PLoS One. 2022 Nov 22;17(11):e0277933. doi: 10.1371/journal.pone.0277933. eCollection 2022.

ABSTRACT

BACKGROUND: Potato is a staple food and a main crop of Bangladesh. Climate plays an important role in different crop production all over the world. Potato production is influenced by climate change, which is occurring at a rapid pace according to time and space.

OBJECTIVE: The main objective of this research is to observe the variation in potato production based on the discrepancy of the variability in the spatial and temporal domains. The research is based on secondary data on potato production from different parts of Bangladesh and five major climate variables for the last 17 years ending with 2020.

METHODS: Bayesian Spatial-temporal modelling for linear, analysis of variance (ANOVA), and auto-Regressive models were used to find the best-fitted model compared with the independent Error Bayesian model. The Watanabe-Akaike information criterion (WAIC) and Deviance Information Criterion (DIC) were used as the model choice criteria and the Markov Chain Monte Carlo (MCMC) method was implemented to generate information about the prior and posterior realizations.

RESULTS: Findings revealed that the ANOVA model under the Spatial-temporal framework was the best model for all model choice and validation criteria. Results depict that there is a significant impact of spatial and temporal variation on potato yield rate. Besides, the windspeed does not show any influence on potato production, however, temperature, humidity, rainfall, and sunshine are important components of potato yield rate in Bangladesh.

CONCLUSION: It is evident that there is a potential impact of climate change on potato production in Bangladesh. Therefore, the authors believed that the findings will be helpful to the policymakers or farmers in developing potato varieties that are resilient to climate change to ensure the United Nations Sustainable Development Goal of zero hunger.

PMID:36413573 | DOI:10.1371/journal.pone.0277933

PLoS One. 2022 Nov 22;17(11):e0277882. doi: 10.1371/journal.pone.0277882. eCollection 2022.

ABSTRACT

BACKGROUND: Little is known about olfactory changes in pediatric COVID-19. It is possible that children under-report chemosensory changes on questionnaires, similar to reports in adults. Here, we aim to describe COVID-19-related olfactory dysfunction in outpatient children. We hypothesized that children with COVID-19 will demonstrate abnormal olfaction on smell-identification testing at a higher rate than children with negative COVID-19 testing.

METHODS: A prospective cross-sectional study was undertaken from June 2020-June 2021 at a tertiary care pediatric hospital. A consecutive sample of 205 outpatients aged 5-21 years undergoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) PCR testing were approached for this study. Patients with prior olfactory dysfunction were excluded. Participants were given a standard COVID-19 symptom questionnaire, a Smell Identification Test (SIT) and home-odorant-based testing within 2 weeks of COVID-19 testing. Prior to study enrollment, power calculation estimated 42 patients to determine difference in rates of SIT results between groups. Data were summarized with descriptive statistics.

RESULTS: Fifty-one patients underwent smell identification testing (23 positive (45%) and 28 negative (55%) for COVID-19; mean age 12.7 years; 60% female). 92% of all patients denied subjective change in their sense of smell or taste but only 58.8% were normosmic on testing. There was no difference in screening questionnaires or SIT scores between COVID-19 positive and negative groups.

CONCLUSIONS: Unlike adults, there was no statistical difference in olfactory function between outpatient COVID-19 positive and negative children. Our findings suggest a discrepancy between objective and patient-reported olfactory function in pediatric patients, and poor performance of current screening protocols at detecting pediatric COVID-19.

PMID:36413561 | DOI:10.1371/journal.pone.0277882