Tag: nevin manimala

Respir Care. 2021 Aug 17:respcare.09053. doi: 10.4187/respcare.09053. Online ahead of print.

ABSTRACT

BACKGROUND: Several markers of oxygenation are used as prognostic markers in acute hypoxemic respiratory failure. Real-world use is limited by the need for invasive measurements and unreliable availability in the electronic health record. A pragmatic, reliable, and accurate marker of acute hypoxemic respiratory failure is needed to facilitate epidemiologic studies, clinical trials, and shared decision-making with patients. F_IO2 is easily obtained at the bedside and from the electronic health record. The F_IO2 trajectory may be a valuable marker of recovery in patients with acute hypoxemic respiratory failure.

METHODS: This was a historical cohort study of adult subjects admitted to an ICU with acute hypoxemic respiratory failure secondary to community-acquired pneumonia and/or ARDS.

RESULTS: Our study included 2,670 subjects. F_IO2 and S_pO2 were consistently more available than was P_aO2 in the electronic health record: (F_IO2 vs S_pO2 vs P_aO2 : 100 vs 100 vs 72.8% on day 1, and 100 vs 99 vs 21% on day 5). A worsening F_IO2 trajectory was associated with reduced ventilator-free days. From days 2 to 5, every increase in F_IO2 by 10% from the previous day was associated with fewer ventilator-free days (on day 2: adjusted mean -1.25 [95% CI -1.45 to -1.05] d, P < .001). The S_pO2 /F_IO2 trajectory also provided prognostic information. On days 3 – 5, an increase in S_pO2 /F_IO2 from the previous day was associated with increased ventilator-free days (on day 3: adjusted mean 2.09 (95% CI 1.44-2.74) d; P < .001). S_pO2 /F_IO2 models did not add predictive information compared with models with F_IO2 alone (on day 2: adjusted F_IO2 vs S_pO2 /F_IO2 R² 0.122 vs 0.119; and on day 3: 0.153 vs 0.163).

CONCLUSIONS: F_IO2 and S_pO2 /F_IO2 are pragmatic and readily available intermediate prognostic markers in acute hypoxic respiratory failure. The F_IO2 trajectory in the first 5 d of ICU admission provided important prognostic information (ventilator-free days). Although the S_pO2 /F_IO2 trajectory was also associated with ventilator-free days, it did not provide more information than the F_IO2 trajectory alone.

PMID:34404689 | DOI:10.4187/respcare.09053

BMJ Open. 2021 Aug 17;11(8):e045544. doi: 10.1136/bmjopen-2020-045544.

ABSTRACT

OBJECTIVES: Anaemia is a global public health problem with major health and socioeconomic consequences. Though childhood anaemia is a major public health problem in Ethiopia, there is limited evidence on the spatio-temporal variability of childhood anaemia over time in the country. Therefore, this study aimed to assess the spatio-temporal distribution and associated factors of childhood anaemia using the Ethiopian Demographic and Health Survey (EDHS) data from 2005 to 2016.

DESIGN: Survey-based cross-sectional study design was employed for the EDHS.

SETTING: Data were collected in all nine regions and two city administrations of Ethiopia in 2005, 2011 and 2016.

PARTICIPANTS: The source population for this study was all children in Ethiopia aged 6-59 months. A total of 21 302 children aged 6-59 months were included in this study.

OUTCOME MEASURE: The outcome variable was child anaemia status.

RESULTS: The prevalence of anaemia declined from 53.9% in 2005 to 44.6% in 2011, but it showed an increase in 2016 to 57.6%. The spatial analysis revealed that the spatial distribution of anaemia varied across the regions. The spatial scan statistics analysis indicated a total of 22 clusters (relative risk (RR)=1.5, p<0.01) in 2005, 180 clusters (RR=1.4, p<0.01) in 2011 and 219 clusters (RR=1.4, p<0. 0.01) in 2016, significant primary clusters were identified. The child’s age, mother’s age, maternal anaemia status, wealth index, birth order, fever, stunting, wasting status and region were significant predictors of childhood anaemia.

CONCLUSIONS: In this study, childhood anaemia remains a public health problem. The spatial distribution of childhood anaemia varied significantly across the country. Individual-level and community-level factors were associated with childhood anaemia. Therefore, in regions with a high risk of childhood anaemia, individual-level and community-level factors should be intensified by allocating additional resources and providing appropriate and tailored strategies.

PMID:34404697 | DOI:10.1136/bmjopen-2020-045544

Cancer Epidemiol Biomarkers Prev. 2021 Aug 17:cebp.0423.2021. doi: 10.1158/1055-9965.EPI-21-0423. Online ahead of print.

ABSTRACT

BACKGROUND: Improvements in cancer survival are usually assessed by comparing survival in grouped years of diagnosis. To enhance analyses of survival trends, we present the joinpoint survival model webtool (JPSurv ) that analyses survival data by single year of diagnosis and estimates changes in survival trends and year-over-year trend measures.

METHODS: We apply JPSurv to relative survival data for individuals diagnosed with female breast cancer, melanoma cancer, Non-Hodgkin Lymphoma (NHL) and Chronic Myeloid Leukemia (CML) between 1975-2015 in the Surveillance, Epidemiology, and End Results (SEER) Program. We estimate the number and location of joinpoints, the trend measures and provide interpretation.

RESULTS: In general, relative survival has substantially improved at least since the mid-1990s for all cancer sites. The largest improvements in 5-year relative survival were observed for distant -stage melanoma after 2009, which increased by almost 3 survival percentage points for each subsequent year of diagnosis, followed by CML in 1995-2010, and NHL in 1995-2003. The modeling also showed that for patients diagnosed with CML after 1995 (compared to before), there was a greater decrease in the probability of dying of the disease in the 4th and 5th years after diagnosis compared to the initial years since diagnosis.

CONCLUSIONS: The greatest increases in trends for distant melanoma, NHL and CML coincided with the introduction of novel treatments, demonstrating the value of JPSurv for estimating and interpreting cancer survival trends.

IMPACT: The JPSurv webtool provides a suite of estimates for analyzing trends in cancer survival that complement traditional descriptive survival analyses.

PMID:34404682 | DOI:10.1158/1055-9965.EPI-21-0423

Cancer Epidemiol Biomarkers Prev. 2021 Aug 17:cebp.1780.2021. doi: 10.1158/1055-9965.EPI-20-1780. Online ahead of print.

ABSTRACT

BACKGROUND: The American Cancer Society (ACS) and the National Cancer Institute collaborate every 5-8 years to update the methods for estimating the numbers of new cancer cases and deaths in the current year for the U.S. and individual states. Herein, we compare our current projection methodology with the next generation of statistical models.

METHODS: A validation study was conducted comparing current projection methods (vector autoregression for incidence; Joinpoint regression for mortality) with the Bayes state space method and novel Joinpoint algorithms. Incidence data from 1996-2010 were projected to 2014 using two inputs: modeled data and observed data with modeled where observed were missing. For mortality, observed data from 1995-2009, 1996-2010, 1997-2011, and 1998-2012, each projected 3 years forward to 2012-2015. Projection methods were evaluated using the average absolute relative deviation (AARD) between observed counts (2014 for incidence, 2012-2015 for mortality) and estimates for 47 cancer sites nationally and 21 sites by state.

RESULTS: A novel Joinpoint model provided a good fit for both incidence and mortality, particularly for the most common cancers in the U.S. Notably, the AARD for cancers with cases in 2014 exceeding 49,000 for this model was 3.4%, nearly half that of the current method (6.3%).

CONCLUSIONS: A data-driven Joinpoint algorithm had versatile performance at the national and state levels and will replace the ACS’s current methods.

IMPACT: This methodology provides estimates of cancer data that are not available for the present year, thus continuing to fill an important gap for advocacy, research, and public health planning.

PMID:34404684 | DOI:10.1158/1055-9965.EPI-20-1780

Cir Esp (Engl Ed). 2021 Aug 14:S2173-5077(21)00215-5. doi: 10.1016/j.cireng.2021.07.013. Online ahead of print.

ABSTRACT

INTRODUCTION: The surgical procedure to repair a subxiphoid incisional hernia is a complex technique due to the anatomical area that it appears. The objective of our study is the analysis of the results obtained with the different surgical techniques performed in our center for 9 years, especially postoperative complications and the recurrence rate.

METHODS: It is an observational, retrospective study from January 2011 to January 2019 of patients operated of subxiphoid incisional hernia in our Unit. We analysed the comorbidities, surgical techniques (preperitoneal hernia repair or TP, and adjusted double mesh technique) and postoperative variable, especially the hernia recurrence. The postoperative complications were summarized flowing the Clavien-Dindo classification.

RESULTS: 42 patients were operated: 22 (52,4%) TP and 20 (47,6%) adjusted double mesh technique. All the complications registered were minor (grade I) and it appeared mostly in TP group (P = .053). The average follow up was 25.8 ± 15.1 months; there were no statistically significant differences in hernia recurrence comparing two treatment groups (P = .288).

CONCLUSIONS: According to our results, TP is the ideal technique to repair a subxiphoid incisional hernia. Adjusted double mesh technique may represent an effective approach with a low complication rate, although globally analyzing the recurrence rate, aponeurosis closure over the preperitoneal mesh entails less impact on it.

PMID:34404629 | DOI:10.1016/j.cireng.2021.07.013

Emerg Med J. 2021 Aug 17:emermed-2020-210363. doi: 10.1136/emermed-2020-210363. Online ahead of print.

ABSTRACT

INTRODUCTION: The standard method of chest compression for adults is a two-handed procedure. One-handed external chest compression (ECC) is used in some situations such as during transport of patients who had an out-of-hospital cardiac arrest, but the quality of one-handed ECC is still not well known. The distribution of force is related to the quality of chest compression and may affect the risk of injury. This study aimed to determine the differences in the quality and potential safety concern between one-handed ECC and two- handed ECC.

METHODS: In this randomised crossover study, participants recruited from National Cheng Kung University Hospital and the ambulance team from the fire bureau were asked to perform one-handed and two-handed ECC on the Resusci Anne manikin according to standard 2015 ECC guidelines. The MatScan Pressure Measurement system was used to investigate the compression pressure and force distribution.

RESULTS: Two-handed ECC had better results than one-handed ECC in terms of the median (IQR) depth (51.00 (41.50-54.75) mm vs 42.00 (27.00-49.00) mm, p=0.018), the proportion of depth accuracy (82.05% (13.95%-99.86%) vs 11.17% (0.00%-42.13%), p=0.028) and the proportion of incomplete recoil (0.23% (0.01%-0.44%) vs 2.42% (0.60%-4.21%), p=0.002). The maximum force (45.72 (36.10-80.84) kgf vs 35.64 (24.13-74.34) kgf, p<0.001) and ulnar-radial force difference (7.13 (-16.58 to 21.07) kgf vs 23.93 (11.19-38.74) kgf, p<0.001) showed statistically significant differences. The perceived fatigue of two-handed ECC versus one-handed ECC was 5.00 (3.00-6.00) vs 6.00 (5.00-8.00), p<0.001.

CONCLUSION: The quality of one-handed ECC, based on depth and recoil, is worse than that of standard two-handed ECC. The pressure and force distribution of one-handed ECC result in greater ulnar pronation of the hand than that of two-handed ECC. One-handed ECC more easily causes operator fatigue. Acknowledging these findings and adjusting training for one-handed ECC would potentially improve the quality of cardiopulmonary resuscitation during transport.

PMID:34404678 | DOI:10.1136/emermed-2020-210363

J Adolesc Health. 2021 Aug 14:S1054-139X(21)00376-1. doi: 10.1016/j.jadohealth.2021.07.019. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study is to test the effects of an electronic screening and feedback tool and training for primary care clinicians on care and adolescent health behaviors.

METHODS: We conducted a stepped-wedge cluster randomized trial with six clinics randomly assigned to sequential crossover from control to intervention periods with clinician training between periods. Adolescents (ages 13-18) with a well visit during the control periods (n = 135) received usual care, while adolescents during the intervention periods (n = 167) received the electronic screening and feedback tool prior to their well visit, with results sent to their clinicians. Adolescents completed surveys at baseline, 1 day, 3 months, 6 months, and 12 months. Linear mixed effects models were used to examine associations between outcomes and treatment, controlling for time as a fixed effect and clinic as a random effect. All analyses employed intent-to-treat analyses and utilized multiple imputations for missing data.

RESULTS: Adolescents who received the intervention had a higher rate of counseling for their endorsed risk behaviors during the well visit (45% vs. 33%, Wald’s T = 2.29, p = .02). There were no significant intervention effects on adolescent satisfaction with the clinician or perception of patient centeredness. The intervention was associated with a small but statistically significant reduction in overall risk score relative to control at 3 months (-.63, 95% confidence interval [-1.07, -.19], Cohen’s d = .21), but not at 6 or 12 months.

CONCLUSIONS: The results suggest that electronic screening and feedback may be associated with small reductions in risk behaviors at 3 months but that changes do not persist at longer term follow-up.

PMID:34404610 | DOI:10.1016/j.jadohealth.2021.07.019

Transfus Apher Sci. 2021 Aug 13:103240. doi: 10.1016/j.transci.2021.103240. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Stem cell transplantation is a growing treatment strategy for most malignant and non- malignant hematological diseases. Plerixafor and granulocyte colony stimulating factor (G-CSF) are usually used in mobilization regimens to increase the CD34⁺ cell count in the harvest. Heparin is a sulphated glycosaminoglycated polymer with 12-15 kDa mass. Heparin inhibits the CXCR4/SDF1 axis, as does plerixafor. In this study, our aim was to investigate the effect of using heparin on stem cell mobilization and harvesting.

MATERIALS AND METHODS: We administered 5000 units of unfractioned heparin intravenously in 150 mL (mL) of isotonic sodium chloride solution, 15 min before the stem cell harvesting procedure to 141 patients who underwent bone marrow transplantation between the years of 2018 and 2019 at our Stem Cell Transplantation Unit. Thirty patients were included as a control group, and they were not given heparin. The study population included patients with multiple myeloma and lymphoma equally in each group.

RESULTS: In all patients hematopoeitic stem cells were successfully harvested in a single cycle of apheresis. In multiple myeloma patients who received heparin, the mean collected CD34⁺ cell number was 8 × 10⁶/kg, and the mean CD34⁺ cell number yield was 12,555/μl. In the control group, the mean collected CD34⁺ cell number was 4,2 × 10⁶/kg, and mean CD34⁺ cell number in yield was 492/μl. In lymphoma patients who received heparin, the mean collected CD34⁺ cell number was 6,8 × 10⁶/kg, and the mean CD34⁺ cell number was 1421/μl. In the control group the mean collected CD34⁺ cell number was 4,3 × 10⁶/kg, and the mean CD34⁺ cell number was 358/μl. The effect of heparin on the collected stem cell number in both myeloma and lymphoma patients was statistically significant (p < 0.01).

CONCLUSIONS: Our results have shown that heparin increases harvested stem cell numbers significantly. Heparin may be a promising agent for stem cell harvesting.

PMID:34404617 | DOI:10.1016/j.transci.2021.103240

Disabil Health J. 2021 Aug 10:101180. doi: 10.1016/j.dhjo.2021.101180. Online ahead of print.

ABSTRACT

BACKGROUND: People with disabilities have higher health care needs, service utilization, and expenditures. They are also more likely to lack insurance and experience unmet need for medical care. There has been limited research on the effects of the Affordable Care Act Medicaid expansion on people with disabilities.

OBJECTIVE: To examine the effects of the Medicaid expansion on health insurance coverage, access, and service use for working-age adults with disabilities.

METHODS: A retrospective study using 11 years (2007-2017) of data from the Medical Expenditure Panel Survey – Household Components, linked to Area Health Resource Files and Local Area Unemployment Statistics (N = 40,995). Difference-in-differences multinomial logistic and linear probability models with state and year fixed-effects were used to estimate the effects.

RESULTS: We found strong evidence of increased Medicaid coverage in expansion states (3.2 to 5.0 percentage points), reasonably strong evidence of reduced private insurance coverage (-2.2 to -2.5 percentage points), and some evidence of reduced uninsured rate (from no effect to -3.7 percentage points). Results suggest that the increase in Medicaid coverage was due at least in part to the “crowd-out” of private insurance in expansion states. No statistically significant effects were detected for access and use outcomes.

CONCLUSIONS: Findings suggest that state Medicaid expansions led to an increase in Medicaid coverage and a decrease in private insurance coverage as well as the uninsured. However, no evidence was found for health care access and use outcomes. Further research into access and use is needed when more data become available for the post-expansion period.

PMID:34404627 | DOI:10.1016/j.dhjo.2021.101180

J Cardiothorac Vasc Anesth. 2021 Jul 9:S1053-0770(21)00573-5. doi: 10.1053/j.jvca.2021.07.001. Online ahead of print.

ABSTRACT

OBJECTIVES: Neutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker that has been evaluated across a variety of surgical disciplines and is widely predictive of poor postoperative outcome, but its value in cardiac surgery is unclear. The authors did this systematic review and meta-analysis to determine the impact of elevated perioperative NLR on survival after cardiac surgery.

DESIGN: Systematic review and meta-analysis of study-level data.

SETTING: Multiple hospitals involved in an international pool of studies.

PARTICIPANTS: Adults undergoing cardiac surgery.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: The authors searched multiple databases from inception until November 2020. They generated summary hazard ratios (HR) and odds ratios (OR) for the association of elevated preoperative NLR with long-term and short-term mortality following cardiac surgery. They separately reported on elevated postoperative NLR. Between-study heterogeneity was explored using metaregression. The authors included 12 studies involving 13,262 patients undergoing cardiac surgery. Elevated preoperative NLR was associated with worse long-term (>30 days) (hazard ratio [HR] 1.56; 95% CI [confidence interval], 1.18-2.06; 8 studies) and short-term (<30 days) mortality (OR 3.18; 95% CI, 1.90-5.30; 7 studies). One study reported the association of elevated postoperative NLR with long-term mortality (HR 8.58; 95% CI, 2.55-28.85). There was considerable between-study heterogeneity for the analysis of long-term mortality (I² statistic 94.39%), which mostly was explained by study-level variables, such as the number of variables adjusted for by included studies and how many of these significantly increased the risk of long-term mortality, high risk of bias, and number of study centers, as well as participant level factors, such as average participant age and hypertension prevalence.

CONCLUSIONS: Perioperative NLR is an independent predictor of short-term and long-term postoperative mortality following cardiac surgery. Further research is required to determine which patient-level factors modify the prognostic value of NLR and to evaluate its role in routine clinical practice.

PMID:34404595 | DOI:10.1053/j.jvca.2021.07.001