Tag: nevin manimala

Int J Pediatr Otorhinolaryngol. 2022 Feb 16;155:111075. doi: 10.1016/j.ijporl.2022.111075. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether children with unilateral sensorineural hearing loss (USNHL) and unilateral conductive hearing loss (UCHL) have higher levels of fatigue than literature reported normal hearing (LRNH) children.

METHODS: This was a cross-sectional survey utilizing the PedsQL™ Multidimensional Fatigue Scale administered to children with unilateral hearing loss (UHL) and their parents at two tertiary care academic medical centers and a nationwide microtia/atresia conference. The PedsQL™ Multidimensional Fatigue Scale was used to compare child and parental proxy reports of fatigue among USNHL, UCHL, and LRNH children. ANOVA and post-hoc Tukey Honest Significant Difference testing were used for statistical analysis.

RESULTS: Of 69 children included in the study, 42 had UCHL (61%) and 27 (39%) had USNHL. Children with USNHL reported more total fatigue (mean 69.1, SD 19.3) than LRNH children (mean 80.5, SD 13.3; difference -11.4; 95% CI: -19.98 to -2.84) and children with UCHL (mean 78.0, SD 14.5; difference -8.95; 95% CI: -17.86 to 0.04). Children with UCHL reported similar levels of fatigue compared to LRNH children (difference -2.5; 95% CI: -9.95 to 5.03). Parents of children with USNHL reported greater levels of fatigue (mean 67.6, SD 22.6) in their children than parents of LRNH children (mean 89.6, SD 11.4; difference -22.0; 95% CI: -29.8 to -14.3) and parents of children with UCHL (mean 76.2, SD 17.3; difference -8.6; 95% CI: -17.5 to 0.21). Parents of children with UCHL also report higher levels of fatigue than parents of LRNH children (difference -13.4; 95% CI: -19.98 to -6.84).

CONCLUSIONS: Children with USNHL reported greater levels of fatigue than LRNH children and children with UCHL. Results implicate cognitive load as an important consideration in children with hearing loss. The measurement of fatigue may be a useful indicator to determine the benefit of intervention (e.g., amplification) for these children.

PMID:35189448 | DOI:10.1016/j.ijporl.2022.111075

Clin Res Hepatol Gastroenterol. 2022 Feb 18:101888. doi: 10.1016/j.clinre.2022.101888. Online ahead of print.

ABSTRACT

BACKGROUND: Low miR-31-3p expression was identified as predictive of anti-EGFR efficacy in RAS-wt mCRC. Primary tumor side was also proposed as a predictive factor of anti-EGFR benefit. This retrospective multicentric study evaluated the predictive role of miR-31-3p in right-sided RAS-wt mCRC patients treated with first-line CT+anti-EGFR or CT+bevacizumab (Beva).

METHODS: Seventy-two right-sided RAS-wt mCRC patients treated in first-line with CT+anti-EGFR (n=43) or Beva (n=29) were included. Overall survival (OS), progression-free survival (PFS) and response rate (RR) were analyzed and stratified according to tumor miR-31-3p expression level and targeted therapy (TT).

RESULTS: BRAF V600E mutation was more frequent in high vs low miR-31-3p expressers (60.6% vs 15.4%, P < 0.001). PFS was significantly longer with CT+Beva than with CT+anti-EGFR (13 vs 7 months; P = 0.024). Among low miR-31-3p expressers, PFS, OS and RR were not significantly different between the two groups, while in high miR-31-3p expressers, only PFS was longer in the CT+Beva group (11 vs 6 months; P = 0.03). In patients treated with CT+anti-EGFR, low miR-31-3p expressers had a significantly longer OS (20 vs 13 months; P = 0.02) than high miR-31-3p expressers. ORR was not significantly different between the two groups of treatment, in both low and high miR-31-3p expressers. MiR-31-3p expression status was statistically correlated between primary tumors and corresponding metastases.

CONCLUSION: In this study, miR-31-3p couldn’t identify a subgroup of patients with right-sided RAS-wt mCRC who might benefit from anti-EGFR and suggest that Beva is the TT of choice in first-line treatment of these patients.

PMID:35189426 | DOI:10.1016/j.clinre.2022.101888

J Acad Consult Liaison Psychiatry. 2022 Feb 18:S2667-2960(22)00018-0. doi: 10.1016/j.jaclp.2022.02.005. Online ahead of print.

ABSTRACT

BACKGROUND: Comorbidity of psychiatric and medical illnesses among older adult populations is highly prevalent and associated with adverse outcomes. Care management is a common form of outpatient support for both psychiatric and medical conditions in which assessment, care planning, and care coordination are provided. Although care management is often remote and delivered by telephone, the evidence supporting this model of care is uncertain.

OBJECTIVE: To perform a systematic review of the literature on remote care management programs for older adult populations with elevated prevalence of depression or anxiety and comorbid chronic medical illness.

METHODS: A systematic review was performed in accordance with PRISMA guidelines. A multi-database search was performed. Articles were included for review if they studied fully remote care management for older adult populations with elevated prevalence of depression or anxiety and chronic medical illness or poor physical health. A narrative synthesis was performed.

RESULTS: A total of 6 articles representing 6 unique studies met inclusion criteria. The 6 studies included 4 randomized controlled trials, 1 case-matched retrospective cohort study, and 1 pre-post analysis. Two studies focused on specific medical conditions. All interventions were entirely telephonic. Five of 6 studies involved an intervention that was 3 to 6 months in duration. Across the 6 studies, care management demonstrated mixed results in terms of impact on psychiatric outcomes and limited impact on medical outcomes. No studies demonstrated a statistically significant impact on health care utilization or cost.

CONCLUSION: Among older adult populations with elevated prevalence of depression or anxiety and comorbid chronic medical illness, remote care management may have favorable impact on psychiatric symptoms, but impact on physical health and health care utilization is uncertain. Future research should focus on identifying effective models and elements of remote care management for this population, with a particular focus on optimizing medical outcomes.

PMID:35189427 | DOI:10.1016/j.jaclp.2022.02.005

World Neurosurg. 2022 Feb 18:S1878-8750(22)00198-X. doi: 10.1016/j.wneu.2022.02.051. Online ahead of print.

ABSTRACT

INTRODUCTION: Predatory journals (PJs) publish research with little to no rigorous peer review in exchange for money. It is unclear what proportion of researchers are vulnerable to PJs and which factors are associated with vulnerability. In this study, the authors evaluate the vulnerability of African neurosurgery researchers to PJs and identify their correlates.

METHODS: A three-part English and French e-surveys were distributed via social media to African consultants and trainees from November 01 to December 01, 2021. Chi-Square, Mann-Whitney U test, Spearman’s Rho correlation, odds ratios, and 95% confidence intervals evaluated bivariable relationships. A p-value <0.05 was considered statistically significant.

RESULTS: One hundred and one participants with a mean age of 34.9 years responded to the survey (response rate=56.1%). Respondents were male (n=83, 82.2%), consultant neurosurgeons (n=39, 38.6%), and from Central Africa (n=34, 33.7%). Sixty-six respondents had published one or more articles in the past, and 13 had published at least one article in a PJ. A PJ had contacted 34 respondents via email, and eight had reviewed articles for a PJ. Nineteen respondents knew about Think. Check. Submit. and 13 knew Beall’s list. Publication in PJs was correlated with the respondents’ age (R=0.23, P=0.02) and total scholarly output (R=0.38, P<001).

CONCLUSION: Young African neurosurgery researchers are vulnerable to PJs primarily because they are not familiar with the concept of PJs or how to identify them.

PMID:35189419 | DOI:10.1016/j.wneu.2022.02.051

Transbound Emerg Dis. 2022 Feb 21. doi: 10.1111/tbed.14491. Online ahead of print.

ABSTRACT

With the recent spread of African swine fever (ASF) in Europe, Asia, and the Caribbean region, after being endemic for decades in Africa, PCR-based commercial kits and various master mixes are increasingly being used in addition to the OIE recommended protocol from King et al., 2003 (World Organisation for animal Health, 2021). Often, the availability and cost of commercial kits or master mixes can be a limiting factor for diagnostic laboratories, in addition to the requirements for transportation and storage of temperature-sensitive reagents in remote areas. In such cases, alternatives should be ready to maximize surveillance and mining of ASF. To evaluate alternatives, we tested five commercial quantitative real-time PCR (qPCR) master mixes from Applied Biosystems, Bio-Rad, Biotechrabbit, Promega and Qiagen using the same primers and probe mix derived from the King et al., 2003 protocol for the sensitivity, specificity, correlation and inter-assay agreement. We further included three ad hoc molecular diagnostic kits [VetMax ^TM African Swine Fever Virus Detection Kit (Applied Biosystems), ID Gene African Swine Fever Duplex (ID-Vet) and Virotype ASF PCR Kit (Qiagen/Indical)]. The limit of detection (LOD) was assessed for each assay. The comparative study panel comprised 83 archived DNA samples from ASFV clinical samples, belonging to five different genotypes from outbreaks in 16 countries in Asia and Africa. The analytical specificity was assessed against a panel of swine pathogens. The LOD ranged from 13 to 41 gene copies per reaction; VetMax ^TM African Swine Fever Virus Detection Kit from Applied Biosystems exhibited the lowest detection limit (13 gene copies per reaction) and iQ Supermix from Bio-Rad the highest detection limit (41 gene copies per reaction). Cq values obtained from the lowest dilution, in which all replicates (n = 25) could still be amplified (50 gene copies per reaction), were not significantly different between kits using Kruskal-Wallis test. Inter assay agreement was assessed using statistical test Fleiss-Kappa and was shown to be excellent in all cases. Agreement using statistical test Bland-Altman was good for samples with Cq values < 25 and moderate for Cq values > 25. We conclude that all the assays evaluated in this study can be used for the routine detection of ASFV. This article is protected by copyright. All rights reserved.

PMID:35189029 | DOI:10.1111/tbed.14491

Intern Med J. 2022 Feb 21. doi: 10.1111/imj.15723. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies demonstrated a ‘weekend effect’ and a ‘night effect’ of increased mortality among patients admitted during weekends or night shifts, presumably due to understaffing. In this study, we rather examined whether death during hospitalization follows a similar effect regardless of admission time.

METHODS: A retrospective cohort study among deceased patients hospitalized in the internal medicine wing of a tertiary medical center in Israel, between 2019-2020. Demographic and medical data were retrieved from electronic medical charts. Causes of death were specifically catogrized. We applied statistical models to test for differences in mortality using incidence rate ratio (IRR) according to the day, time and cause of death.

RESULTS: 1,278 deceased patients were included. All-cause mortality was similar among weekends and weekdays. When sepsis was the cause of death, higher IRR were demonstrated on Fridays in comparison to weekdays (IRR 1.4 95% CI 1.1-1.9, p<0.05). Other causes of death were not consistent with a ‘weekend effect’. Mortality during nightshifts was higher in comparison to the afternoon (IRR 1.5 95% CI 1.3-4.7) and similar to the morning (IRR 1 95% CI 0.9-1.2).

CONCLUSION: Our study did not find a pattern of ‘weekend effect’ or ‘night effect’ on all-cause mortality among hospitalized patients in internal medicine wards. Our findings suggests that perhaps specifically death from sepsis, and not all-cause mortality, can be used as a surrogate for the measurement of understaffing or quality of care in the internal ward. This article is protected by copyright. All rights reserved.

PMID:35189020 | DOI:10.1111/imj.15723

Int J Med Robot. 2022 Feb 21:e2383. doi: 10.1002/rcs.2383. Online ahead of print.

ABSTRACT

BACKGROUND: Robotic surgery may facilitate complex procedures such as right colectomy with complete mesocolic excision (CME) and shorten the learning curve. This study aimed to compare senior and junior surgeons’ results in performing robotic right colectomy (RRC) with CME and intracorporeal anastomosis (IA) for right colon cancer.

MATERIALS AND METHODS: Between January 2015 and April 2020, a total of 161 patients underwent RRC with CME. After propensity score matching, two groups of 31 patients for each surgeon were formed. Intraoperative, postoperative and pathological outcomes were the variables assessed.

RESULTS: No statistically significant difference was recorded between the two groups. The senior surgeon experienced 16.1% minor complications (Clavien-Dindo I-II) and 3.2% major complications (Clavien-Dindo III-IV), while the novice surgeon reported 19.3% and 3.2% rates of minor and major adverse events, respectively.

CONCLUSIONS: After a structured training protocol, a novice may obtain comparable results to an expert in performing RRC with CME. This article is protected by copyright. All rights reserved.

PMID:35189021 | DOI:10.1002/rcs.2383

JAMA Neurol. 2022 Feb 21. doi: 10.1001/jamaneurol.2021.5420. Online ahead of print.

ABSTRACT

IMPORTANCE: Early posttraumatic seizures (EPS) that may occur following a traumatic brain injury (TBI) are associated with poorer outcomes and development of posttraumatic epilepsy (PTE).

OBJECTIVE: To evaluate risk factors for EPS, associated morbidity and mortality, and contribution to PTE.

DESIGN, SETTING, AND PARTICIPANTS: Data were collected from an Australian registry-based cohort study of adults (age ≥18 years) with moderate to severe TBI from January 2005 to December 2019, with 2-year follow-up. The statewide trauma registry, conducted on an opt-out basis in Victoria (population 6.5 million), had 15 152 patients with moderate to severe TBI identified via Abbreviated Injury Scale (AIS) head severity score, with an opt-out rate less than 0.5% (opt-out n = 136).

MAIN OUTCOMES AND MEASURES: EPS were identified via International Statistical Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes recorded after the acute admission. Outcome measures also included in-hospital metrics, 2-year outcomes including PTE, and post-discharge mortality. Adaptive least absolute shrinkage and selection operator (LASSO) regression was used to build a prediction model for risk factors of EPS.

RESULTS: Among the 15 152 participants (10 457 [69%] male; median [IQR] age, 60 [35-79] y), 416 (2.7%) were identified with EPS, including 27 (0.2%) with status epilepticus. Significant risk factors on multivariable analysis for developing EPS were younger age, higher Charlson Comorbidity Index, TBI sustained from a low fall, subdural hemorrhage, subarachnoid hemorrhage, higher Injury Severity Score, and greater head injury severity, measured using the AIS and Glasgow Coma Score. After adjustment for confounders, EPS were associated with increased ICU admission and ICU length of stay, ventilation and duration, hospital length of stay, and discharge to inpatient rehabilitation rather than home, but not in-hospital mortality. Outcomes in TBI admission survivors at 24 months, including mortality (relative risk [RR] = 2.14; 95% CI, 1.32-3.46; P = .002), development of PTE (RR = 2.91; 95% CI, 2.22-3.81; P < .001), and use of antiseizure medications (RR = 2.44; 95% CI, 1.98-3.02; P < .001), were poorer for cases with EPS after adjustment for confounders. The prediction model for EPS had an area under the receiver operating characteristic curve of 0.72 (95% CI, 0.66-0.79), sensitivity of 66%, and specificity of 73% in the validation set.

DISCUSSION: We identified important risk factors for EPS following moderate to severe TBI. Early posttraumatic seizures were associated with longer ICU and hospital admissions, ICU ventilation, and poorer 24-month outcomes including mortality and development of PTE.

PMID:35188950 | DOI:10.1001/jamaneurol.2021.5420

J Am Acad Orthop Surg Glob Res Rev. 2022 Feb 21;6(2). doi: 10.5435/JAAOSGlobal-D-22-00002.

ABSTRACT

INTRODUCTION: Fasciotomy is the standard of care to treat acute compartment syndrome (ACS). Although fasciotomies often prevent serious complications, postoperative complications can be notable. Surgical site infection (SSI) in these patients is as high as 30%. The objective of this study was to determine factors that increase the risk of SSI in patients with ACS.

METHODS: A retrospective review of 142 patients with compartment syndrome over 10 years was done. We collected basic demographics, mechanism of trauma, time to fasciotomy, incidence of SSI, use of prophylactic antibiotics, and type and time to wound closure. Statistical analysis of continuous variables was done using the Student t-test, ANOVA, multivariable regression model, and categorical variables were compared using the chi-square test.

RESULTS: Twenty-five patients with ACS (17.6%) developed infection that required additional treatment. In the multivariate regression model, there were significant differences in median time to closure in patients with infection versus those without, odds ratio: 1.06 (Confidence Interval 95% [1.00 to 1.11]), P = 0.036. No differences were observed in infection based on the mechanism of injury, wound management modality, or the presence of associated diagnoses.

CONCLUSION: In patients with ACS, the time to closure after fasciotomy is associated with the incidence of SSI. There seems to be a golden period for closure at 4 to 5 days after fasciotomy. The ability to close is often limited by multiple factors, but the correlation between time to closure and infection in this study suggests that it is worth exploring different closure methods if the wound cannot be closed primarily within the given timeframe.

PMID:35188898 | DOI:10.5435/JAAOSGlobal-D-22-00002

J Patient Saf. 2022 Mar 1;18(2):102-110. doi: 10.1097/PTS.0000000000000819.

ABSTRACT

OBJECTIVE: This study aimed to cross-culturally adapt, validate, and pilot the Patient Reported Experiences and Outcomes of Safety in Primary Care questionnaire for its use in Spain.

METHODS: After setting up an expert panel to determine its content validity, the questionnaire was translated and back-translated, and subjected to cognitive testing. The questionnaire was piloted in a cross-sectional study in 10 primary health care centers in Spain. Fifty patients per center completed the questionnaire while waiting for an appointment. We estimated (i) the acceptability of the questionnaire (response rate), (ii) scores distribution (floor and ceiling effects), (iii) internal consistency (Cronbach α), and (iv) construct validity (exploratory factor analyses and correlation between scales). To examine patients’ evaluations of patient safety, we followed a mixed-methods approach: (i) statistical analyses at the scale and item levels based on responses to standardized items and (ii) qualitative content analysis based on responses to open-ended questions.

RESULTS: Complete data were collected from 493 patients (participation rate, 77%). A ceiling effect was observed for 3 scales (“safety problems,” “harm severity,” “harm needs”). The internal consistency was adequate (α > 0.7) for the majority of scales. Exploratory factor analysis and correlation between scales suggested an appropriate construct validity. Two hundred twenty-six (45.8%) respondents experienced at least 1 safety problem, and 109 (23.2%) reported harm in the previous 12 months.

CONCLUSIONS: The multidimensional primary health care patient safety instrument Patient Reported Experiences and Outcomes of Safety in Primary Care is now available for its use in Spain. Initial testing demonstrates its potential for use in primary care. Future developments will further address its use in actual clinical practice.

PMID:35188925 | DOI:10.1097/PTS.0000000000000819