Tag: nevin manimala

Surg Obes Relat Dis. 2021 Feb 6:S1550-7289(21)00081-2. doi: 10.1016/j.soard.2021.01.042. Online ahead of print.

ABSTRACT

BACKGROUND: Studies on early postoperative readmissions after bariatric surgery (BS) have examined readmissions as a single entity, regardless of urgency. Strategies to lower nonurgent readmissions would reduce unnecessary hospital utilization.

OBJECTIVES: To identify predictors of urgent readmissions (UR) versus nonurgent readmissions (NUR) at 30 days post-BS.

SETTING: Single academic institution.

METHODS: Patients undergoing primary BS over 2 years (n = 589) were retrospectively reviewed. Baseline demographic, medical, and hospitalization data were compared between readmitted patients, stratified by urgency, and nonreadmitted patients. Multivariate regression models of UR and NUR were created using variables with a P value ≤ .2 on univariate analyses. A P value ≤ .05 was considered statistically significant.

RESULTS: There were 39 documented instances of 30-day readmissions, of which 44% (n = 17) were NUR; NUR patients were more likely to be female (100% versus 78.2% male; P = .03) and trended toward being younger, experiencing ≥2 perioperative complications, and having a longer index hospital length of stay (LOS). Patients with URs had a higher baseline BMI (52.5 ± 11.4 kg/m² versus 48.7 ± 8.3 kg/m², respectively; P = .04), were more likely to have sleep apnea (77.3% versus 56.1%, respectively; P = .05), had a longer LOS (3 versus 2 d, respectively; P = .007), and were more likely to have ≥2 postoperative complications (46% versus 17.0%, respectively; P = .003) compared with those with an NUR. Independent predictors of NUR included public insurance (odds ratio [OR] = 3.7; 95% confidence interval [CI], 1.17-11.67; P = .03), younger age (OR = 1.05; 95% CI, 1-1.01; P = .04), and female sex, while URs were independently predicted by LOS (OR = 1.3; 95% CI, 1.04-1.5; P = .02).

CONCLUSIONS: Public insurance appears to be associated with NURs, while LOS predicts URs after BS. This suggests an important dichotomy within readmissions based on urgency, which has important implications for targeted quality initiatives.

PMID:33715991 | DOI:10.1016/j.soard.2021.01.042

J Cyst Fibros. 2021 Mar 11:S1569-1993(21)00049-7. doi: 10.1016/j.jcf.2021.02.014. Online ahead of print.

ABSTRACT

BACKGROUND: Home spirometry with regular symptom assessment is one strategy to track lung health to intervene early in episodes of pulmonary exacerbations (PE). In a multi-center randomized controlled trial home spirometry and symptom tracking demonstrated no significant differences regarding the primary clinical endpoint, FEV₁, compared to usual care, but did identify differences in healthcare utilization. We used data from the Early Intervention in Cystic Fibrosis Exacerbation (eICE) study to evaluate whether home monitoring of PE is a cost-minimizing intervention in the context of this randomized trial.

METHODS: We reviewed healthcare resource utilization of all 267 eICE participants, including outpatient visits, antibiotics and hospitalizations. Prices were identified in the IBM/Watson MarketScan^Ⓡ Commercial Claims and Encounters Databases and averaged over the 2014-2017 period. Using total healthcare utilization costs, we generated summary statistics by intervention and protocol arm (total cost, mean cost, standard deviation). We performed Welch Two Sample t-tests to determine if total costs and cost by type of utilization differed significantly between groups.

RESULTS: Outpatient visit costs were significantly higher by 13% in the Early Intervention (EI) than in the usual care (UC) arm ($3,345 vs. $2,966). We found no significant differences in outpatient antibiotic, hospitalization, or total health care costs between the arms.

CONCLUSIONS: Within the context of the eICE trial, outpatient visits were significantly higher in those with experimental home spirometry care, but that did not translate into statistically significant differences of overall health care costs between the two arms.

PMID:33715993 | DOI:10.1016/j.jcf.2021.02.014

Vet J. 2021 Feb 27:105650. doi: 10.1016/j.tvjl.2021.105650. Online ahead of print.

ABSTRACT

Determining ideal pacing rates to meet physiological needs and optimizing programming to prevent unnecessary right ventricular pacing in dogs requires an understanding of heart rate profiles and applicable pacing technology. The heart rate and rhythm of the dog is complex necessitating investigation of rate requirements of activity and circadian influences. Overlaying this information are a multiplicity of other factors such as age, breed, temperament, cardiovascular disease and underlining rhythm disorders that contribute to the difficulty in making general conclusions. However, all such information permits better implementation of programming options with the goal of better outcomes. In this review (Part 1 of a two-part review) instantaneous heart rate, rolling average heart rate, simple average heart rate, heart rate tachograms, RR interval tachograms (2D, 3D and dynamic), and Poincaré plots (2D, 3D and dynamic) are discussed as they apply to decisions in the determination and examination of pacing rates for dogs programmed in the VVI pacing mode (Ventricular paced, Ventricular sensed, Inhibited pacing). The applicable pacing operations available for three pacemaker companies are reviewed (Abbott, Biotronik/Dextronix, and Medtronic). The programmable options considered include: slowest pacing rate without additional features to extend the pacing interval, sleep/rest rate preferences, hysteresis to lengthen pacing interval following intrinsic beats, and intermittent increases in pacing following abrupt loss of intrinsic rhythm. Recommendations are suggested for follow-up of individual dogs with examination of pacing statistics and Holter monitoring.

PMID:33715961 | DOI:10.1016/j.tvjl.2021.105650

J Craniomaxillofac Surg. 2021 Feb 27:S1010-5182(21)00078-0. doi: 10.1016/j.jcms.2021.02.021. Online ahead of print.

ABSTRACT

The aim of this study was to determine whether patients benefit from a secondary reconstruction since it carries the risks of no improvement or worsening of their current situation. Patients treated with individual computer-aided-design/computer-aided-manufacturing (CAD/CAM) ceramic implants were reviewed. To ascertain changes throughout the secondary reconstruction, the study investigators reviewed ophthalmological examinations, took volumetric measurements of the orbits and asked the patients for evaluation of their situation before and after the reconstruction. Points addressed were double vision, visual acuity, field of vision, limitations in daily life and aesthetic considerations. A total of 14 patients were reviewed and 11 answered the questionnaire. Ophthalmological examinations showed that the physical integrity of the eye was maintained. Volumetric measurements preopeatively (33.94 ± 3.24 cm³) and postoperatively (30.67 ± 2.07 cm³) showed that a statistically significant overcorrection of orbital volume leads to good functional and aesthetic outcomes. Patients’ subjective opinions were that they greatly benefitted, especially concerning limitations in daily life, which improved by 4.4 ± 2.8 points out of 10 possible points, and aesthetics, with an improvement of 5.9 ± 1.78 points. Based on these findings, we conclude that secondary reconstructions contribute to improvement of the patients’ quality of life and therefore should be considered as an option to improve patients’ condition.

PMID:33715966 | DOI:10.1016/j.jcms.2021.02.021

J Am Pharm Assoc (2003). 2021 Feb 19:S1544-3191(21)00075-3. doi: 10.1016/j.japh.2021.02.007. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study is to evaluate the incidence of glycemic relapse in patients who attained their glycosylated hemoglobin (A1C) goal through a health system-wide collaborative primary care-based pharmacist- and Certified Diabetes Care and Education Specialist (CDCES)-led type 2 diabetes (T2D) management program and to identify relapse risk factors.

METHODS: This retrospective cohort study examined patients with T2D in the diabetes management program with a baseline A1C of at least 9% who attained their A1C goal. The primary outcome was incidence of glycemic relapse. Time to relapse was estimated using Kaplan-Meier curve, and a cox proportional hazards model was fitted to identify the risk factors for glycemic relapse.

RESULTS: Three hundred sixty-two patients were followed-up for a median of 10.5 (interquartile range 12.1) months after program completion; 38 patients (10.5%) experienced a glycemic relapse. Kaplan-Meier analysis estimated a 12-month relapse rate of 8.3%. The presence of a medication adherence barrier, presence of a higher number of chronic medications at baseline, presence of a baseline body mass index (BMI) of 30-39.9, and use of insulin at program completion increased risk for glycemic relapse in a univariate model. In multivariate regression, baseline BMI of 30-39.9 remained statistically significant. Older age at baseline was associated with a statistically significantly decreased relapse risk in both models.

CONCLUSION: This study highlights a low incidence of glycemic relapse for patients with T2D who reach their A1C goal through a collaborative primary care-based pharmacist- and CDCES-led T2D management program. The presence of risk factors for glycemic relapse may indicate a need for ongoing intensive care despite achieving A1C goal.

PMID:33715974 | DOI:10.1016/j.japh.2021.02.007

J Acad Nutr Diet. 2021 Mar 11:S2212-2672(21)00077-0. doi: 10.1016/j.jand.2021.02.004. Online ahead of print.

ABSTRACT

BACKGROUND: Consistent, evidence-based child feeding guidance targeted to parents of children ages birth to 24 months (B-24) is needed for early childhood obesity prevention.

OBJECTIVE: The aim was to develop and pretest a comprehensive set of child feeding and obesity prevention messages for parents of children ages B-24.

DESIGN: A qualitative, 2-phase protocol, grounded in social and behavior change, was used as a conceptual interview framework to pilot test early childhood feeding messages with parents.

PARTICIPANTS/SETTING: Participants were parents (n = 23) of children ages B-24.

METHODS: A core set of 12 messages and supporting materials were developed for parents of children ages B-24 based on previous research findings, current research evidence, and feeding guidance. Parents were individually interviewed using a semistructured script along with additional questions to rank perceptions of message qualities.

MAIN OUTCOME MEASURES: Overall comprehension, importance, believability, ease of implementation, and likelihood of use of messages were assessed.

STATISTICAL ANALYSIS PERFORMED: Data analysis included qualitative thematic analysis and descriptive statistics for Likert-scaled responses.

RESULTS: Participants were primarily female, non-Hispanic White, with a mean age of 33.3 ± 6.8 years and at least a bachelor’s degree. Overall, most messages were understood, believable, perceived as important, and feasible by parents. Messages related to starting solid foods, encouraging child control of intake and self-feeding, and food allergen guidance were perceived as more difficult and less likely to be implemented by parents.

CONCLUSIONS: Additional research is needed to evaluate actual implementation of messages by diverse parents and resulting outcomes including impact on child weight.

PMID:33715977 | DOI:10.1016/j.jand.2021.02.004

Intensive Crit Care Nurs. 2021 Mar 11:103028. doi: 10.1016/j.iccn.2021.103028. Online ahead of print.

NO ABSTRACT

PMID:33715957 | DOI:10.1016/j.iccn.2021.103028

Nurs Open. 2021 Mar 14. doi: 10.1002/nop2.852. Online ahead of print.

ABSTRACT

AIMS: To investigate the attitudes and beliefs towards the implementation of nurse prescribing among general nurses and nurse specialists.

DESIGN: A cross-sectional survey among general nurses and nurse specialists was conducted in seven provinces and one autonomous region in mainland China using convenience sampling method.

METHODS: The attitudes and beliefs towards nurse prescribing were assessed using the Nurse Attitudes and Beliefs towards Nurse prescribing scale, of which Cronbach’s coefficient was 0.902, retest reliability was 0.808. Respondents from eight hospitals across the country were employed to complete an online questionnaire.

RESULTS: Nurse specialists (n = 399) had statistically significantly more favourable intentions towards nurse prescribing than general nurses (n = 415; 105.64 ± 12.83 vs. 96.39 ± 13.16; p < .001). The years of clinical work experience, professional title, education degree were positively correlated with general nurses’ and nurse specialists’ attitudes and beliefs towards nurse prescribing (p < .05). Among nurse specialists, the variety of specialties and whether they work in nurse-led clinics on an outpatient basis have positively influence on their intentions towards nurse prescribing (p < .05).

PMID:33715286 | DOI:10.1002/nop2.852

Int J Ment Health Nurs. 2021 Mar 14. doi: 10.1111/inm.12846. Online ahead of print.

ABSTRACT

Despite the global prevalence of mental disorders being widely acknowledged, mental illness, complex trauma and the significant impact on individuals, families and communities continues to be poorly recognized, under-diagnosed and underreported. Based on the 2017 Australian census, one-in-five (20%) people have experienced some type of mental illness within the last 12 months (Australian Bureau of Statistics [ABS], 2019). The prevalence rate of mental illness in culturally and linguistically diverse (CALD) communities is difficult to estimate due to cultural and linguistic issues and underutilization of mental health services. In particular, little epidemiological data is available about the prevalence of mental illness in the Somali-Australian community. The aim of this study was to identify the perceived barriers to help-seeking for mental health for Somali-Australian women. A qualitative descriptive study incorporating focus group discussions with 31 Somali-Australian women was conducted in Melbourne, Australia. Braun & Clarke’s (2006) thematic analysis was applied to the data. Four themes relating to help-seeking barriers were abstracted. Influence of faith explored how Islam can impact the person views on mental illness. Stigma focused on the relationship between public and self-stigma and help-seeking. Mistrust of Western healthcare system describes the participants concerns about the cultural disconnect between the community and the Western healthcare system. Finally, denial of mental illness reflected the community views on mental health. This study provides an insight into the factors that influence the Somali-Australian community help-seeking with mental health services. The findings have implications for mental health professionals and the Somali-Australian community.

PMID:33715289 | DOI:10.1111/inm.12846

Health Promot J Austr. 2021 Mar 14. doi: 10.1002/hpja.479. Online ahead of print.

ABSTRACT

BACKGROUND: Childhood obesity is a significant public health issue. Sugar sweetened beverage (SSB) consumption contributes to this and adolescents are high consumers. This paper provides a descriptive overview of a school-based intervention to address this.

METHODS: 61 secondary schools in New South Wales were randomised to receive a behavioural intervention (BI), a chilled water station (CWS), both interventions or neither (control). The BI was delivered through classroom lessons, school-based promotion and vaccination clinic. The CWS intervention included the installation of one CWS per school. Intervention effectiveness over time was assessed via student surveys at baseline, post-intervention and follow-up (individual-level outcomes), feedback from teachers and vaccination nurses, a school information survey, and remotely monitored CWS water usage (school-level outcomes).

RESULTS: Teachers reported the BI was useful in teaching students about drinking water and negative consequences of SSBs. Nurses considered the post-vaccination waiting period a good opportunity to deliver health promotion messages. Students in this group showed statistically significant changes in knowledge about SSBs, dehydration effects and changes in daily SSB consumption (T1 23.18%; T3 18.20%). Positive feedback regarding CWSs was received with an increase in water consumption reported for students in this group (T1 86.15% to T3 89.66%) and a statistically significant increase in students carrying a water bottle to school and filling it observed.

CONCLUSIONS: Both interventions were readily implemented with high levels of acceptability and impact on students’ knowledge and SSB consumption. The study demonstrates how to promote water consumption in schools utilising two different interventions. SO WHAT?: Evidence regarding how to decrease SSB consumption among secondary school students has been strengthened.

PMID:33715238 | DOI:10.1002/hpja.479