Tag: nevin manimala

J Hosp Med. 2022 Feb;17(2):96-103. doi: 10.1002/jhm.12782. Epub 2022 Feb 14.

ABSTRACT

OBJECTIVE: Prolonged pre-procedural fasting in children is associated with decreased patient and family satisfaction and increased patient hemodynamic instability. Practice guidelines recommend clear liquid fasting times of 2 h. We aimed to decrease pre-procedural clear liquid fasting time from 10 h 13 min to 5 h for pediatric hospital medicine (PHM) patients.

METHODS: All children admitted to the PHM service at a quaternary care children’s hospital with an NPO (nil per os) order associated with a procedure requiring general anesthesia or sedation from November 2, 2017 to September 19, 2021 were included. The primary outcome measure was the average time from clear liquid fasting end time to anesthesia start time. The process measure was the percent of NPO orders including a documented clear liquid fasting end time. Balancing measures were aspiration events and case delays/cancellations. Statistical process control charts were used to analyze outcomes.

RESULTS: Shortly after implementation of a SmartPhrase in the NPO order, there was special cause variation resulting in a centerline shift from a mean of 10 h 13 min to 6 h 37 min and an increase in the process measure from a baseline of 2%-52%. Following implementation of a hospital-wide change to the NPO order format, another centerline shift to 6 h 7 min occurred which has been sustained for 6 months. No aspiration events and four NPO violations occurred during the intervention period.

CONCLUSION: Quality improvement methodology and higher reliability interventions safely decreased the average pre-procedural fasting time in hospitalized children.

PMID:35504576 | DOI:10.1002/jhm.12782

J Hosp Med. 2022 Jan;17(1):28-35. doi: 10.1002/jhm.27410.

ABSTRACT

BACKGROUND: Clinical documentation is a key component of practice. Trainees rarely receive formal training in documentation or assessment of their documentation. Effective methods of improving documentation remain unknown.

OBJECTIVE: The objective of this study was to determine if the implementation of a documentation curriculum led to improvement in admission note quality.

DESIGNS: Admission notes written prior to implementation of the curriculum and after the curriculum intervention were assessed. Notes were assessed from two-time frames for both years to account for improvement with time not associated with the intervention.

SETTINGS AND PARTICIPANTS: Admission notes written by University of Cincinnati interns were assessed.

INTERVENTIONS: The documentation curriculum consisted of educational sessions and routine admission note assessments with feedback.

MAIN OUTCOMES AND MEASURES: Admission notes were assessed via the 16 checklist items and two global assessment items of the Admission Note Assessment Tool (ANAT).

RESULTS: Six ANAT items showed statistically significant differences. The review of systems item improved with the intervention only (odds ratio: 3.61, p < .001) while the assessment and plan item 1 and global assessment item 2 improved with time only (β = .08, p = .03 and β = .25, p = .02, respectively) in univariate models. In univariate models the physical exam item, diagnostic data item 2, and global assessment item 1 showed improvement with both intervention and time, respectively, with additive effects seen in models with both intervention and time.

CONCLUSION: Several aspects of documentation can improve with a formal documentation curriculum which includes a routine assessment with feedback, and some aspects of documentation improve with time.

PMID:35504574 | DOI:10.1002/jhm.27410

Photodiagnosis Photodyn Ther. 2022 Apr 30:102895. doi: 10.1016/j.pdpdt.2022.102895. Online ahead of print.

ABSTRACT

AIM: The aim of the present study was to evaluate the effect of antimicrobial photodynamic therapy (aPDT) as an adjunctive treatment to topical antiviral therapy for the treatment of children having herpetic gingivostomatitis MATERIALS AND METHODS: : 45 individuals (age group 12-18 years) with herpetic gingivostomatitis (HG) were divided into three groups on the basis of provision of treatment. (a) Group A: topical anti-viral therapy (TAT) (n=14, mean age = 17.0 years) (b) Group B: antimicrobial photodynamic therapy (aPDT) (n=15, mean age =17.7 years) and (c) Group C: topical anti-viral therapy + adjunctive aPDT (n=16, mean age = 18.0 years) respectively. Pain scores [visual analogue scale (VAS) and McGill Pain Questionnaire (MPQ)] were assessed and HSV-1 was quantified. ENZYME LINKED IMMUNOSORBENT ASSAY (ELISA) was used to compute the pro-inflammatory cytokine including interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α). The analysis of the mean values and inter group comparisons were evaluated with the Mann-Whitney test. The Friedman test was used to establish the comparison of the changes observed in HSV quantification, pain scores, and pro-inflammatory cytokines. ANOVA tests were employed for the quantification of differences observed at follow-ups. The assessments for the clinical trial were done at baseline, immediate after post-op, two, and four weeks, and three and six months respectively.

RESULTS: According to the analysis of the data obtained after the clinical assessment, the three groups reported a decrease in the pain scores, HSV-1 quantification and levels of the pro-inflammatory cytokines. However, Group C (TAT + aPDT) reported improvement in the observed parameters which was statistically significant in comparison to Group A (TAT) and Group B (aPDT) respectively.

CONCLUSION: Antimicrobial photodynamic therapy (aPDT) in conjunction with topical antiviral therapy (TAT) helped in reducing the pain scores and pro-inflammatory cytokine levels in herpetic gingivostomatitis among children.

PMID:35504550 | DOI:10.1016/j.pdpdt.2022.102895

Ann Hepatol. 2022 Apr 30:100721. doi: 10.1016/j.aohep.2022.100721. Online ahead of print.

ABSTRACT

BACKGROUND: Recent studies have proposed two distinctive types of obesity, metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO), based on various physiological factors. This study sought to explore the relationship between the metabolic obesity types and the incidence of liver cirrhosis (LC) in a large nationally-representative population.

METHODS: Data on 27,629 adults with MHO or MUHO, were analyzed from the Korea National Health and Nutrition Examination Survey (KNANES) obtained from 2015 through 2019. Four categories of metabolic health and weight (MHW) were generated for analysis: 1) MHO, 2) MUHO, 3) Metabolically unhealthy normal weight (MUHNW), and 4) Metabolically healthy normal weight (MHNW). Statistical analyses were performed with univariate and multivariate logistic regression.

RESULTS: The prevalence of LC did not show statistically significant differences among the MHW categories: 0.5% in MHO, 0.4% in MUHO, 0.2% in MHNW, and 0.3% in MUHNW. The unadjusted analysis showed a significant association between self-reported LC and MUHO, but this association was not evident in the adjusted analysis. In the adjusted analysis of the prevalence of laboratory LC, a significant association emerged in the MUHO group, followed in descending order of magnitude by the MHO and MUHNW groups. A favorable fasting blood glucose level was the only factor associated with increased prevalence of reported LC in MUHO.

CONCLUSIONS: The study demonstrated a difference in the prevalence of LC between MHO and MUHO. Our study concludes that the MHO phenotype is a transient status with regard to metabolic abnormalities, and caution is necessary when evaluating MHO.

PMID:35504573 | DOI:10.1016/j.aohep.2022.100721

Int J Radiat Oncol Biol Phys. 2022 Apr 30:S0360-3016(22)00393-5. doi: 10.1016/j.ijrobp.2022.04.035. Online ahead of print.

ABSTRACT

PURPOSE: The goal of this study was to evaluate disease, survival, and toxicity outcomes following unilateral radiotherapy treatment for tonsillar cancer.

METHODS: A retrospective study was performed of patients treated at our institution between 2000-2018. Summary statistics were used to assess the cohort by patient characteristics and treatments delivered. The Kaplan-Meier method was used to determine survival outcomes.

RESULTS: The cohort constituted 403 patients, including 343 (85%) with clinical and/or radiographic evidence of ipsilateral cervical nodal disease including 181 (45%) with multiple involved nodes. HPV was detected in 294 (73%) tumors. Median follow-up time was 5.8 years. Disease relapse was infrequent-with local recurrence in 9 (2%) patients, neck recurrence in 13 (3%) patients, and recurrence in the unirradiated contralateral neck in 9 (2%) of patients. Five- and ten-year overall survival rates were 94% and 89%, respectively. Gastrostomy tubes were needed in 32 (9%) patients, and no patient had a feeding tube 6 months after therapy.

CONCLUSION: For patients with well lateralized tonsillar tumors and no clinically evident adenopathy of the contralateral neck, unilateral radiotherapy offers favorable rates of disease outcomes and a relatively low toxicity profile.

PMID:35504500 | DOI:10.1016/j.ijrobp.2022.04.035

J Allergy Clin Immunol. 2022 Apr 30:S0091-6749(22)00617-0. doi: 10.1016/j.jaci.2022.04.023. Online ahead of print.

ABSTRACT

BACKGROUND: In subjects with systemic mastocytosis the number of mast cells is elevated manifold. These patients frequently suffer unpredictable and recurrent life-threatening mast cell activation (MCA) events.

OBJECTIVE: Our aim was to analyze the derangements of chemokine and cytokine concentrations during severe MCA attacks METHODS: Samples from an indolent systemic mastocytosis patient were used for this study. A total of 41 chemokines and cytokines were simultaneously measured in triplicate and at multiple time points during two severe and two moderate MCA events. These were compared to 3 to 5 baseline samples, taken when clinical symptoms were not present.

RESULTS: During the severe MCA event, which required 2 days of treatment in the intensive care unit, peak CCL3, IL-1ra, IL-5, IL-6, IL-10, IL-13 and GM-CSF concentrations were statistically significantly elevated 29-, 99-, 44-, 280-, 93-, 7- and 6-fold above baseline respectively. A very similar pattern was observed during the second severe MCA event. In the moderate MCA event with PCR-proven Influenza A infection, the Th1-associated cytokines INFα, INFγ and TNFα were only statistically significantly elevated 5- to 7-fold above baseline. The correlation coefficients between highly elevated histamine and cytokine concentrations during the acute phase were >95% indicating the same cellular origin, possibly activated mast cells.

CONCLUSIONS: One of the severe MCA events led to life-threatening symptoms over several days. During this event, the massive release of Th2 cytokines induced a hyperinflammatory state, fulfilling recently published criteria for cytokine release syndrome. Administration of IL-6 and IL-5 inhibiting biologicals might significantly shorten the acute phase of severe MCA events, likely offering significant clinical benefits to mastocytosis patients.

PMID:35504498 | DOI:10.1016/j.jaci.2022.04.023

J Org Chem. 2022 May 3. doi: 10.1021/acs.joc.2c00369. Online ahead of print.

ABSTRACT

6-Azidotetrazolo[5,1-a]phthalazine (ATPH) is a nitrogen-rich compound of surprisingly broad interest. It is purported to be a natural product, yet it is closely related to substances developed as explosives and is highly polymorphic despite having a nearly planar structure with little flexibility. Seven solid forms of ATPH have been characterized by single-crystal X-ray diffraction. The structures show diverse patterns of molecular organization, including both stacked sheets and herringbone packing. In all cases, N···N and C-H···N interactions play key roles in ensuring molecular cohesion. The high polymorphism of ATPH appears to arise in part from the ability of virtually every atom of nitrogen and hydrogen in the molecule to take part in close N···N and C-H···N contacts. As a result, adjacent molecules can adopt many different relative orientations that are energetically similar, thereby generating a polymorphic landscape with an unusually high density of potential structures. This landscape has been explored in detail by the computational prediction of crystal structures. Studying ATPH has provided insights into the field of energetic materials, where access to multiple polymorphs can be used to improve performance and clarify how it depends on molecular packing. In addition, our work with ATPH shows how valuable insights into molecular crystallization, often gleaned from statistical analyses of structural databases, can also come from in-depth empirical and theoretical studies of single compounds that show distinctive behavior.

PMID:35504046 | DOI:10.1021/acs.joc.2c00369

Retina. 2022 Apr 22. doi: 10.1097/IAE.0000000000003510. Online ahead of print.

ABSTRACT

PURPOSE: To determine effects of baseline characteristics and laser type performed on outcomes in people with proliferative diabetic retinopathy (PDR) undergoing panretinal photocoagulation (PRP).

METHODS: Medical records of all consecutive patients with PDR naïve to PRP, identified using an electronic database, evaluated at the Macula Clinic, Belfast Health and Social Care Trust, receiving their first PRP between 1st January 2016 and 30th June 2017, and followed for a minimum of 6 months following stabilization of PDR, were retrospectively reviewed. Outcomes included time to stabilization following PRP, progression of PDR, and mean change in best-corrected visual acuity from baseline to last follow-up. Cox regression was used to estimate hazard ratios (HRs) for the effect of baseline characteristics and type of laser on outcomes following treatment.

RESULTS: One hundred and fourteen patients (135 eyes) with a mean age of 57.6 (SD: 13.1) years were included, 67% males. People receiving pattern or mixed laser had a statistically significantly delayed stabilization (HR: 0.54, p=0.004; and HR: 0.41, p=0.001, respectively) and increased risk of progression (HR: 1.83, p=0.028; and HR: 2.04, p=0.018, respectively) when compared to those receiving standard laser. Among other potential predictors in multivariable regression analysis, only vitreous hemorrhage and fibrosis or traction at baseline increased risk of progression (HR: 1.70, p=0.017; and HR: 4.14, p<0.001 respectively). Baseline characteristics and type of laser had no statistically significant effect on vision.

CONCLUSION: These findings should be considered when selecting laser treatment, planning surveillance, and counselling patients with PDR undergoing PRP.

PMID:35504028 | DOI:10.1097/IAE.0000000000003510

Eur J Sport Sci. 2022 May 3:1-8. doi: 10.1080/17461391.2022.2065927. Online ahead of print.

ABSTRACT

Seminal work has found a negative association between physical exercise and impulsivity levels in humans. This paper aims to strengthen these findings by evaluating the association between the amount of self-reported physical exercise per week and emotion-related impulsivity whilst considering age and gender as covariates on a large-scale dataset.Participants completed an online self-report questionnaire about emotion-related impulsivity (i.e. Feelings Trigger Action) and exercise-related questions. After quality control, 773 participants were included in the analysis. Correlational analyses and a multiple regression model explaining the emotion-related impulsivity scores via the amount of exercise per week and demographic characteristics (i.e. age and gender) were performed.The number of hours spent exercising per week was significantly inversely correlated with the Feelings Trigger Action score (r = -.131, p < .001) and two out of its three subscales. The multiple linear regression model showed that hours of exercise per week and gender were significantly associated with the Feelings Trigger Action score (std. β = -.122, p < .001), however, this model explained only 3.2% of the overall variance.This large-scale dataset confirms seminal work displaying an inverse association between emotion-related impulsivity and hours of exercise per week. Further studies are required to understand the mechanisms underlying the relationship between the two variables. HighlightsThis study (N = 773) confirms seminal work on the connection between exercise and impulsivity.When controlling for demographic variables, the amount of exercise per week was inversely correlated (small effect size) with emotion-related impulsivity levels.In the multiple-regression model, hours of exercise per week and gender were significantly associated with the Feelings Trigger Action score.

PMID:35504027 | DOI:10.1080/17461391.2022.2065927

J Nerv Ment Dis. 2022 Apr 30. doi: 10.1097/NMD.0000000000001540. Online ahead of print.

ABSTRACT

The use of music as a basis for overcoming depressive personality disorders is possible only if the individual is ready for this therapy. Music therapy affects, first of all, the very structure of personality, its dynamic filling with current social and political tendencies, and allows to highlight problem areas, which are often viewed as complex in the structure of other psychological problems. The purpose of the current study was the determination and justification of the corresponding criteria in relation to this, as well as the methodology for diagnosing the studied phenomenon. The diagnostics involved five groups of psychologists (in general, 438 persons). The preparedness of therapists for preventive and remedial work with patients with depressive conduct disorder was evaluated. To test the truth of the statistical hypothesis the Wilcoxon-Mann-Whitney criterion was used. The novelty of the article is determined by the fact that the use of music is considered only as a therapeutic measure, and not associated with the use of medication or sedation. The developed system of the use of music therapy can be implemented only under the condition of applying special factors and principles. These factors include, first of all, the ability to respond to the personality and, if necessary, adjust the therapy strategy.

PMID:35504020 | DOI:10.1097/NMD.0000000000001540