Tag: nevin manimala

Microsurgery. 2022 Aug 5. doi: 10.1002/micr.30946. Online ahead of print.

ABSTRACT

BACKGROUND: Free flap surgeries are useful procedures for lower-extremity reconstruction. Recipient vein selection for anastomosis is important to avoid venous congestion and thrombosis. Although deep or superficial venous system can be used as a recipient vein site, there is a lack of consensus on which system would be superior to avoid postoperative complications. This systematic review and meta-analysis aimed to assess the differences in outcomes between deep and superficial vein anastomosis for lower-extremity free flap reconstruction.

METHODS: The PubMed, Scopus, Web of Science, and Cochrane Library medical databases were systematically searched from inception to April 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A comparative meta-analysis was conducted on studies of deep and superficial venous system anastomosis outcomes, comprising vascular thrombosis, reoperation, complete flap necrosis, and any flap necrosis. The fixed-effects meta-analysis model was used when low heterogeneity (I² < 50%) was present.

RESULTS: Six studies with 789 flaps were included in the analysis and qualitative and quantitative syntheses. The rate of vascular thrombosis (8.2% vs. 15.1%; p = .005) was significantly lower for flaps involving deep vein anastomosis than for those involving superficial vein anastomosis. The rate of reoperation after deep vein anastomosis was lower than that after superficial vein anastomosis, with no statistically significant difference (9.0% vs. 14.7%; p = .06). There were no significant differences in the rates of complete (2.5% vs. 2.0%; p = .90) or any flap necrosis (7.0% vs. 9.8%; p = .20).

CONCLUSION: Deep vein anastomosis might be recommended for avoiding vascular thrombosis.

PMID:35930261 | DOI:10.1002/micr.30946

Int J Occup Saf Ergon. 2022 Aug 5:1-19. doi: 10.1080/10803548.2022.2110359. Online ahead of print.

ABSTRACT

BACKGROUND: Workplace inspection supports improving working environment and workers’ conditions. Changes in workplaces following inspections are construed as the inspection’s outcome. Inspectors need to be flexible, which affects their performance. This study aimed to design and develop a tool for inspection performance assessment based on identified inspection prerequisites and evaluate the tool’s appropriateness for performance assessment.

METHODS: Occupational safety and health experts were tasked to rank identified prerequisite for effective inspection performance, based on their experiences and perception of importance of the prerequisites. The outcome of the ranking exercise formed the basis for weighting and assignment of values to the prerequisites subgoals. A code was written creating an inspection performance assessment tool interface, which inspectors can assess their workplace inspection performance.Inspectors from different national authorities tested and evaluated the tool, providing feedback appropriateness for measuring inspection performance.

RESULTS: Statistical analysis of the data collected showed much agreement between the subject matter experts. A five-level performance consideration depending on the inspection performance index attained was implemented. On testing and evaluation of the tool, high average rating for the test criteria were obtained, with data from inspectors from different authorities showing higher interrater consistency, and thus reliability.

CONCLUSION: TIPA provides a systematic inspection performance quantification supporting inspectors’ self-actualisation, improving performance. Furthermore, the tool’s generality allows for use irrespective of the inspection area without affecting inspection areas specificity adjustments. In addition, the ease of use adds to its utility, and with agreement on the tool’s appropriateness for inspection performance assessment.

PMID:35930255 | DOI:10.1080/10803548.2022.2110359

J Palliat Med. 2022 Aug 5. doi: 10.1089/jpm.2022.0266. Online ahead of print.

ABSTRACT

Background: The opioid rotation ratios (ORRs) and conversion ratios (CRs) used worldwide among palliative care (PC) professionals to perform opioid rotations (ORs) and route conversions may have a wide variation. Methods: We surveyed PC professionals on opioid ratios used through email to the Multinational Association of Supportive Care in Cancer’s PC study group and Twitter and Facebook posts between September and November 2020. Results: We received 370 responses from respondents from 53 countries: 276 (76%) were physicians, 46 (13%) advanced practice providers, 39 (11%), and 9 respondents did not report their profession. There were statistically significant variations in median CR from intravenous (IV) to oral morphine (2-3), IV to oral hydromorphone (2-4.5), ORR from IV hydromorphone to oral morphine (10-20), and ORR from transdermal fentanyl mcg/hour to oral morphine (2-3.5) across various groups. Conclusion: This survey highlights the wide variation in ORRs and CRs among PC clinicians worldwide and the need for further research to standardize practice.

PMID:35930252 | DOI:10.1089/jpm.2022.0266

Int J Occup Saf Ergon. 2022 Aug 5:1-33. doi: 10.1080/10803548.2022.2108653. Online ahead of print.

ABSTRACT

OBJECTIVE: Investigate the prevalence, risk factors and impacts of neck and back pain among supermarkets cashiers in Botswana.

MATERIALS AND METHODS: A cross-sectional study was conducted among supermarkets cashiers using self-administered. Data were analysed using χ² and logistic regression models. Statistical significance was assumed at p<0.05.

RESULTS: A total of 174 supermarkets cashiers participated in this study majority of whom were females (72%). The prevalence of lower back pain was 69%, upper back pain 53% and neck pain 37%. Increasing age was associated with neck 95% CI [1.43-5.15] and upper back 95% CI [1.43-3.60] pain. Cashiers working at low work surface and overreaching for items were 19 and 11 times more likely to report neck 95% CI [1.7-255.9] and lower back 95% CI [1.84-62.1] pain, respectively. Almost 6% of cashiers who reported lower back pain reported considering changing jobs due to pain.

CONCLUSIONS: More than two-thirds, half and about two-fifths of supermarket cashiers reported lower back, upper back and neck pain, respectively. Individual and work-related factors were associated with neck and/or back pain. Back and neck pain workers’ health and wellbeing, their families, workplace productivity and the health care system. To reduce their prevalence and progression, supermarkets should introduce occupational health and safety talks.

PMID:35930246 | DOI:10.1080/10803548.2022.2108653

J Clin Exp Neuropsychol. 2022 Aug 5:1-12. doi: 10.1080/13803395.2022.2107183. Online ahead of print.

ABSTRACT

OBJECTIVE: The Memory for Intentions Test (MIsT) is a clinical measure of prospective memory that has strong evidence for convergent, discriminative, and ecological validity. This study uses a conceptual replication design to evaluate the latent structure of the MIsT in two parallel samples who commonly experience prospective memory deficits: older adults and people living with HIV disease.

PARTICIPANTS AND METHODS: Study participants included 303 people with HIV disease (ages 18-67) and 267 community-dwelling older adults (ages 50-91). Confirmatory factor analyses of the MIsT were conducted separately in each sample. We evaluated a one-factor model, as well as three two-factor models with the MIsT items loading onto each factor based on cue type, delay interval, or response modality.

RESULTS: The one-factor model provided the best (and most parsimonious) fit to the data in both study samples. All two-factor models also demonstrated good fit statistics, although correlations between the two factors in each model were high and none of the two-factor models provided a significantly better fit than the one-factor model.

CONCLUSIONS: Results of this conceptual replication study provide support for a robust factor structure of the MIsT across older adults and people with HIV disease. A total score for the MIsT provides the most parsimonious solution, although available evidence and theory also support the potential use of subscales (e.g., cue type). Future studies of the MIsT would be useful to determine its psychometrics in different clinical populations and across demographic factors (e.g., race/ethnicity).

PMID:35930244 | DOI:10.1080/13803395.2022.2107183

Appl Neuropsychol Adult. 2022 Aug 5:1-8. doi: 10.1080/23279095.2022.2106572. Online ahead of print.

ABSTRACT

Early detection of cognitive impairment is of paramount importance in clinical settings, with several brief screening tools having been developed for that purpose. The present study sought to evaluate the clinical utility of the Saint Louis University Mental Status examination (SLUMS) at identifying examinees with normal cognition, mild cognitive impairment, or dementia syndrome using the criterion of a comprehensive neuropsychological assessment. Two hundred sixty-three examinees (M age = 67.84 ± 12.72; 59.3% female; 81.4% white) were referred for comprehensive neuropsychological evaluation at a private, Mid-Atlantic medical center. Using original cutoff scores, the SLUMS correctly classified just over half (55.1%) of examinees. Classification statistics suggested modified cutoff scores for mild cognitive impairment (≤24) and dementia (≤17) with strong discriminability between cognitive status groups (AUCs ranged from .834 to .986). These proposed revised cutoff scores improved overall concordance between SLUMS and diagnostic conclusions from comprehensive clinical neuropsychological testing, correctly classifying nearly two-thirds of examinees (65.4%). The SLUMS and its revised cutoff scores appear to have clinical utility for cognitive screening in primary care and neurological settings to inform treatment plans and appropriate referrals for comprehensive neuropsychological assessment.

PMID:35930237 | DOI:10.1080/23279095.2022.2106572

Cardiovasc Toxicol. 2022 Aug 5. doi: 10.1007/s12012-022-09764-4. Online ahead of print.

ABSTRACT

Many drugs carry some risk of QT interval prolongation, which can lead to life-threatening dysrhythmias including Torsades de Pointes (TdP). CredibleMeds.org identifies medications categorized as “Known Risk of TdP” but does not stratify risk in acute supratherapeutic ingestions. We sought to determine the proportion of cases exhibiting QTc prolongation and life-threatening dysrhythmias including ventricular tachycardia (VT)/ventricular fibrillation (VF), TdP, and asystole in patients exposed to these substances. Retrospective chart review of cases reported to our Regional Poison Center from 2014 to 2019 of exposures to one or more of the “Known Risk” substances was performed. Demographics, therapies, clinical effects, and medical outcome for each case were analyzed. There were 1125 exposures, of which 760 had a documented QTc interval. QTc ≥ 500 ms was reported in 138 (18.2%) of the 760 cases. The most common “Known Risk” substances were citalopram, escitalopram and cocaine. Although not in the “Known Risk” category, mirtazapine, amitriptyline, diphenhydramine, and trazodone had a statistically significant association with QTc > 500 ms. Life-threatening dysrhythmias occurred in 13 cases, with VT/VF in 6 of the 760 (0.8%) cases, and one case of TdP. Flecainide (OR 11.1, 95% CI 2.2-55.8) and methadone (OR 7.1, 95% CI 2.1-23.4) were associated with increased risk of all life-threatening dysrhythmias. Exposures to medications on the Credible Meds list of “Known Risk of TdP” QTc prolongation is common, but life-threatening dysrhythmias are rare. Mirtazapine, amitriptyline, diphenhydramine, and trazodone were associated with prolonged QTc. Flecainide and methadone had the highest associated risk of life-threatening dysrhythmias.

PMID:35930218 | DOI:10.1007/s12012-022-09764-4

AIDS Behav. 2022 Aug 5. doi: 10.1007/s10461-022-03782-7. Online ahead of print.

ABSTRACT

Although HIV pre-exposure prophylaxis (PrEP) is free in Thailand, many transgender women discontinue taking it after initiation. We determined the loss to follow-up (LTFU) rate of transgender women who initiated PrEP at the Mplus Foundation, Chiang Mai, Thailand, and identified associated risk factors using Cox proportional hazard models. Of 235 participants who initiated PrEP, 59 (55%) out of 108 remaining participants had reactive syphilis. The LTFU rate at 6 months was 38% (95% confidence interval [CI]: 29-48%). Multivariable analysis indicates that LTFU is independently associated with age ≥ 26 years old (adjusted hazard ratio [aHR] = 2.09; 95% CI: 1.06-4.14) and reactive syphilis (aHR = 1.98; 95% CI:1.01-3.88). Delayed appointment scheduling by the PrEP providers and the syphilis clinic was associated with transgender women having reactive syphilis, and the lockdown policy during the COVID-19 pandemic might have influenced them to discontinue PrEP and their subsequent LTFU.

PMID:35930202 | DOI:10.1007/s10461-022-03782-7

Environ Monit Assess. 2022 Aug 5;194(9):646. doi: 10.1007/s10661-022-10299-y.

ABSTRACT

Digital Shoreline Analysis System (DSAS) is the most frequently used coastal engineering system for shoreline change quantification. Factors like human and system errors, wrong perception of the shoreline changes, and non-exact data sources may cause errors in the measured data. Detection and modification of such data can increase the accuracy of results. At present, the DSAS tool lacks this capability, so this research aimed to present a new module for DSAS to detect uncertain data in shoreline change rate measurements. The module’s basis for detecting uncertain data is to use statistical methods: adjusted boxplot, Grubbs’ test, standard deviation tests, median test, modified Z-score test, and voting method. The module’s performance was evaluated based on a data set obtained through Qeshm Island shoreline change quantification in Iran. The details of these methods, the prepared module, the case study, and the shoreline change measurement statistical methods were discussed in this study. The results showed the acceptable output of this module in detecting uncertain data.

PMID:35930198 | DOI:10.1007/s10661-022-10299-y

Sleep Breath. 2022 Aug 5. doi: 10.1007/s11325-022-02687-y. Online ahead of print.

ABSTRACT

PURPOSE: Obstructive sleep apnea (OSA) can impair cognition. Continuous positive airway pressure (CPAP) is a recommended treatment for OSA but its effectiveness on cognitive improvement is uncertain, a finding which may be biased by various durations and adherence to treatment with CPAP. In a meta-analysis assessing high-quality randomized controlled trials (RCTs), we estimated whether or not CPAP benefits cognition in patients with OSA.

METHODS: PRISMA criteria were followed in the performance of this meta-analysis. The weighted mean difference (WMD) and 95% confidence interval (CI) of six neuropsychological scores covering eight cognitive domains were used to evaluate the benefit between CPAP and non-CPAP interventions. Subgroups of different therapeutic durations and adherence, which were divided into short-term (< 8 weeks) and long-term (≥ 12 weeks) durations, and poor (nighttime < 4 h/night) and good (nighttime ≥ 4 h/night) adherence were also analyzed.

RESULTS: Among 16 RCTs, 1529 participants with OSA were included. Comparing the CPAP group and the control group for all treatment durations and adherence, a mild improvement for digit span forward which reflected short-term memory was observed (WMD[95%CI] = 0.67[0.03,1.31], p = 0.04). Trail making test-part B, which reflected executive function was improved for participants with OSA who had good adherence to CPAP (WMD[95%CI] = – 6.24[- 12.60,0.12], p = 0.05). Patients with OSA who received short-term CPAP treatment (WMD[95%CI] = – 7.20[- 12.57, – 1.82], p = 0.009) had a significant improvement in executive function when compared with controls. There was no statistical difference for all scales between long-term (≥ 12 weeks) CPAP treatment group and control group.

CONCLUSION: The effectiveness of CPAP on cognitive improvement in patients with OSA is limited, although good adherence to CPAP can mildly benefit executive function with short-term effectiveness.

PMID:35930191 | DOI:10.1007/s11325-022-02687-y