Tag: nevin manimala

Cancer Nurs. 2021 Dec 30. doi: 10.1097/NCC.0000000000001052. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with advanced cancer are increasingly experiencing financial hardship (FH) and associated negative health outcomes.

OBJECTIVE: The aims of this study were to describe FH and explore its relationship to quality of life (QOL) in patients with advanced cancer receiving outpatient palliative care (PC).

METHODS: Validated questionnaires assessed FH, QOL dimensions, symptom burden, and sociodemographic and clinical characteristics. Descriptive statistics characterized the sample and described FH. Pearson correlation and linear regression assessed relationships between FH and QOL.

RESULTS: The average participant (n = 78) age was 56.6 (SD, 12.2) years. Most were female (56.4%), White (50%) or Black (46.2%), and had a range of education, partner statuses, and cancer diagnoses. Median time since cancer diagnosis was 35.5 months (interquartile range, 9-57.3 months). Highest mean symptom burden scores were for pain (2.5 [SD, 1.0]) and fatigue (2.0 [SD, 1.1]), on a 0- to 3-point scale (higher score representing worse symptom burden). The median COST (COmphrehensive Score for financial Toxicity) score was 15.0 (interquartile range, 9.0-23.0). Most (70%) had some (n = 43) or extreme (n = 9) difficulty paying for basic needs. Greater than 28% (n = 21) incurred cancer-related debt. Multivariate models indicated that FH negatively affected role limitations due to physical health (P = .008), pain (P = .003), and emotional well-being (P = .017) QOL dimensions.

CONCLUSIONS: Financial hardship, QOL, and symptom burden scores demonstrate need for continued support for and research among patients with advanced cancer. Data support links between FH and important QOL dimensions. Larger, longitudinal studies are needed to understand how FH affects QOL in patients with advanced cancer.

IMPLICATIONS FOR PRACTICE: Proactive financial assessment and interventions are needed to support patients with advanced cancer experiencing the cumulative effects of cancer and its treatment.

PMID:34974507 | DOI:10.1097/NCC.0000000000001052

J Clin Gastroenterol. 2021 Dec 31. doi: 10.1097/MCG.0000000000001655. Online ahead of print.

ABSTRACT

INTRODUCTION: Intravenous immunoglobulin (IVIG) has been shown in a small pilot series to be helpful for some patients with gastroparesis that is refractory to drugs, devices, and surgical therapies. Many but not all patients have serologic neuromuscular markers. We hypothesize that those patients with serologic markers and/or longer duration of therapy would have better responses to IVIG.

MATERIALS AND METHODS: We studied 47 patients with a diagnosis of gastroparesis and gastroparesis-like syndrome that had all failed previous therapies including available and investigational drugs, devices, and/or pyloric therapies. Patients had a standardized 12-week course of IVIG, dosed as 400 mg/kg per week intravenously. Symptom assessment was done with Food and Drug Administration (FDA) compliant traditional patient-reported outcomes. Success to IVIG was defined as 20% or greater reduction in average symptom scores from baseline to the latest evaluation.

RESULTS: Fourteen patients (30%) had a response, and 33 (70%) had no response per our definition. Patients responding had a higher glutamic acid decarboxylase 65 positivity (64% vs. 30%, P=0.049, missing=3) and longer duration of therapy (>12 wk/continuous: 86% vs. 48%, P=0.09).

CONCLUSIONS: In this moderately sized open-label series of refractory patients with gastroparesis symptoms treated with IVIG, 30% of patients responded. While serologic markers and extended therapies show a trend to greater response, neither was statistically significant, except for glutamic acid decarboxylase 65 which showed a higher positivity rate in responders. We conclude that a clinical trial of IVIG may be warranted in severely refractory patients with gastroparesis symptoms.

PMID:34974494 | DOI:10.1097/MCG.0000000000001655

Nurs Educ Perspect. 2021 Dec 21. doi: 10.1097/01.NEP.0000000000000920. Online ahead of print.

ABSTRACT

AIM: This study investigated the impact of an interprofessional mock code on students’ comfort and competency related to Parkinson’s disease (PD) medication administration during care transitions.

BACKGROUD: Patients with PD are at increased risk for medication errors during hospitalization. Individualization of PD medication creates vulnerability during care transitions.

METHOD: Four interprofessional groups took part in this study: baccalaureate degree senior nursing students (n = 113), master’s level nurse anesthesia students (n = 35), doctor of osteopathic medicine fourth-year students (n = 32), and doctor of clinical psychology fourth-year students (n = 22). Groups participated in an unfolding case study simulation involving a mock code with a focus on the omission of time-sensitive PD medication. Pre- and postsimulation test results were compared.

RESULTS: Findings indicated an increased understanding among three of the four groups relating to medication timing during care transitions.

CONCLUSION: All groups improved with respect to perceived comfort and competency.

PMID:34974503 | DOI:10.1097/01.NEP.0000000000000920

J Acquir Immune Defic Syndr. 2021 Dec 21. doi: 10.1097/QAI.0000000000002901. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic and its associated socio-economic disruptions has disproportionally affected marginalized populations including people living with HIV (PLHIV). Little is known about how the pandemic has impacted populations experiencing multiple forms of stigma, discrimination and violence such as female sex workers (FSW) living with HIV.

METHODS: We conducted a cross-sectional survey between August and December 2020 among 187 FSW living with HIV in the Dominican Republic (DR) to examine the impact of COVID-19. Using multivariable logistic regression, we examined associations between COVID-19-related financial concerns, mental health, substance use and partner abuse on engagement in HIV care and ART adherence. We conducted mediation analysis to assess whether mental health challenges mediated the impact of partner abuse or substance use on HIV outcomes.

RESULTS: Most participants reported no income (72%) or a substantial decline in income (25%) since the COVID-19 pandemic. Approximately one third (34%) reported COVID-19 had an impact on their HIV care and treatment. Greater COVID-19 financial concerns (aOR=1.14, 95% CI: 1.02-1.27), mental health challenges (aOR=1.38, 95% CI: 1.06-1.79) and partner emotional abuse (aOR=2.62, 95% CI: 1.01-6.79) were associated with higher odds of negatively impacted HIV care, respectively. The relationship between increased emotional partner abuse and negatively impacted HIV care was mediated by greater COVID-19-related mental health challenges.

CONCLUSION: FSW living with HIV in the DR have been significantly impacted by the COVID-19 pandemic. Targeted interventions that address structural (financial security, partner abuse) and psychosocial (mental health) factors are needed to sustain HIV outcomes and well-being.

PMID:34974474 | DOI:10.1097/QAI.0000000000002901

J Clin Gastroenterol. 2021 Dec 31. doi: 10.1097/MCG.0000000000001650. Online ahead of print.

ABSTRACT

OBJECTIVE: There is still no gold standard regarding the optimal circumference of antireflux mucosectomy (ARMS) in patients with treatment-refractory gastroesophageal reflux disease (GERD). The aim of this study is to assess the safety and effectiveness of resection procedures when the circumferences are different.

PATIENTS AND METHODS: Thirty-two patients with treatment-refractory GERD were allocated into group A (16 cases) and group B (16 cases) by randomization. In group A and group B, a 2/3 and 1/2 circumference, 1.5 cm wide mucosal resection of the gastric cardia was performed. Health-related quality of life (HRQOL), frequency scale for the symptoms of GERD (FSSG), DeMeester scores and acid exposure time (AET) were accessed at baseline and at 24 months after treatment. Physical component summaries (PCS), mental component summaries (MCS), and RE-specific summary (RES) scores were calculated.

RESULTS: All patients had successful surgical procedures and no bleeding, perforation, or dysphagia occurred. The PCS, MCS, and RES scores of post-ARMS were higher than those of pre-ARMS in groups A and B, and the FSSG, DeMeester scores and AET decreased after ARMS in both groups, with differences that were statistically significant (P<0.05). The changes in PCS, MCS, RES, FSSG, DeMeester scores, and AET were greater in group A than in group B, with significant differences in PCS, MCS, RES, and FSSG scores (P<0.05), but no significant differences in, DeMeester scores and AET (P>0.05).

CONCLUSION: ARMS is an effective treatment for treatment-refractory GERD. Moreover, we recommend the 2/3 circumference, 1.5 cm wide mucosal resection of the gastric cardia.

PMID:34974493 | DOI:10.1097/MCG.0000000000001650

Transplantation. 2021 Dec 28. doi: 10.1097/TP.0000000000004026. Online ahead of print.

ABSTRACT

BACKGROUND: Sex differences in kidney graft loss rates were reported in the United States. Whether these differences are present in other countries is unknown.

METHODS: We estimated the association between recipient sex and death-censored graft loss in patients of all ages recorded in the Scientific Registry of Transplant Recipients, Australia and New Zealand Dialysis and Transplant Registry, and Collaborative Transplant Study registries who received a first deceased donor kidney transplant (1988-2019). We used multivariable Cox regression models, accounting for the modifying effects of donor sex and recipient age, in each registry separately; results were combined using individual patient data meta-analysis.

RESULTS: We analyzed 438 585 patients. Young female patients 13-24 y old had the highest crude graft loss rates (female donor: 5.66; male donor: 5.50 per 100 person-years). Among young recipients of male donors, females showed higher graft loss risks than males (0-12 y: adjusted hazard ratio [aHR] 1.42, (95% confidence interval [CI], 1.17-1.73); 13-24 y: 1.24 (1.17-1.32); 25-44 y: 1.09 (1.06-1.13)). When the donor was female, there were no significant differences by recipient sex among those of age <45 y; however, the aHR for females was 0.93 (0.89-0.98) in 45-59 y-old and 0.89 (0.86-0.93) in ≥ 60 y-old recipients. Findings were similar for all 3 registries in most age intervals; statistically significant heterogeneity was seen only among 13-24-y-old recipients of a female donor (I2 = 71.5%, P = 0.03).

CONCLUSION: There is an association between recipient sex and kidney transplantation survival that is modified by recipient age and donor sex.

PMID:34974454 | DOI:10.1097/TP.0000000000004026

Optom Vis Sci. 2021 Dec 29. doi: 10.1097/OPX.0000000000001850. Online ahead of print.

ABSTRACT

SIGNIFICANCE: Psychophysical estimates of spatial and depth vision have been shown to be better following bilateral ReLEx small incision lenticule extraction (SMILE) refractive surgery for myopia, relative to Photorefractive Keratectomy (PRK) and Femtosecond-LASIK (FS-LASIK). The present study provides the optical basis for these findings using computational image quality analysis.

PURPOSE: To compare longitudinal changes in higher-order wavefront aberrations and image quality before and after bilateral PRK, FS-LASIK, and SMILE refractive procedures for correcting myopia.

METHODS: Wavefront aberrations and image quality of both the eyes of 106 subjects (n = 40 for FS-LASIK and SMILE and n = 26 for PRK) were determined pre-operatively and at 1-week, 1-month, 3-months, and 6-months post-operative intervals using computational through-focus analysis for 6 mm pupil diameter. Image quality was quantified in terms of its peak value and its interocular difference, residual defocus that was needed to achieve peak image quality (best focus) and the depth of focus.

RESULTS: The increase in RMS deviations of higher-order aberrations postoperatively was lesser after SMILE [1mth visit median (25th to 75th interquartile range): 0.34 μm (0.28 to 0.39 μm)] than after PRK [0.80 μm (0.74 to 0.87 μm)] and FS-LASIK [0.74 μm (0.59 to 0.83 μm)] (P ≤ .001), all relative to pre-operative values [0.20 μm (0.15 to 0.30 μm)]. The peak image quality dropped and its interocular difference increased, best focus shifted myopically by 0.5 – 0.75D and depth of focus widened significantly following PRK and FS-LASIK surgeries, all relative to pre-operative values (P < .001). All these changes were negligible but statistically significantly in a minority of instances following SMILE surgery (P ≥ .01).

CONCLUSIONS: While all three refractive surgeries correct myopia, the image quality and its similarity between eyes are better and closer to pre-operative values following SMILE, compared to FS-LASIK and PRK. These results can be explained from the underlying increase in higher-order wavefront aberrations experienced by the eye postoperatively.

PMID:34974458 | DOI:10.1097/OPX.0000000000001850

Transplantation. 2021 Dec 28. doi: 10.1097/TP.0000000000004042. Online ahead of print.

ABSTRACT

At the outset of solid organ transplantation, genetic variation between donors and recipients was recognized as a major player in mechanisms such as allograft tolerance and rejection. Genome-wide association studies have been very successful in identifying novel variant-trait associations, but have been difficult to perform in the field of solid organ transplantation due to complex covariates, era effects, and poor statistical power for detecting donor-recipient interactions. To overcome a lack of statistical power, consortia such as the International Genetics and Translational Research in Transplantation Network have been established. Studies have focused on the consequences of genetic dissimilarities between donors and recipients and have reported associations between polymorphisms in candidate genes or their regulatory regions with transplantation outcomes. However, knowledge on the exact influence of genetic variation is limited due to a lack of comprehensive characterization and harmonization of recipients’ or donors’ phenotypes and validation using an experimental approach. Causal research in genetics has evolved from agnostic discovery in genome-wide association studies to functional annotation and clarification of underlying molecular mechanisms in translational studies. In this overview, we summarize how the recent advances and progresses in the field of genetics and genomics have improved the understanding of outcomes after solid organ transplantation.

PMID:34974452 | DOI:10.1097/TP.0000000000004042

J Parkinsons Dis. 2021 Dec 26. doi: 10.3233/JPD-212833. Online ahead of print.

NO ABSTRACT

PMID:34974437 | DOI:10.3233/JPD-212833

Restor Neurol Neurosci. 2021 Dec 30. doi: 10.3233/RNN-211156. Online ahead of print.

ABSTRACT

BACKGROUND: Childhood hearing impairment is a major disability associated with delayed motor development. The affected Fine motor performance in children with sensorineural hearing loss (SNHL) could be due to dynamic balance deficits and visual-motor incoordination.

OBJECTIVE: This study was designed to investigate the effects of fine motor exercises with or without balancing exercises on fine motor skills in children with SNHL.

METHODS: One hundred and eighty (180) children their age ranged from 8 to 18 years old diagnosed with SNHL were selected. They were divided into three groups, 60 children (control group) practiced only their ordinary activities of daily living, 60 children (fine motor exercises group) practiced fine motor exercises, and 60 children (fine motor and balance exercise) group practiced fine motor and balance exercises. The outcomes were assessed by the Bruininks Oseretsky Test of the motor proficiency second edition scale (BOT-2).

RESULTS: Generally, there was a statistically significant difference between control group and fine motor exercises group where (p < 0.05), besides, there was a statistically significant difference between control group and fine motor and balance exercises group where (p < 0.05). But, there was no statistically significant difference between fine motor exercises group and fine motor and balance exercises group where (p > 0.05).

CONCLUSIONS: The Fine Motor performance of children with SNHL has been improved by Fine motor with or without balancing exercises according to (BOT-2).

PMID:34974444 | DOI:10.3233/RNN-211156