Tag: nevin manimala

Int J Hyg Environ Health. 2022 May 24;243:113987. doi: 10.1016/j.ijheh.2022.113987. Online ahead of print.

ABSTRACT

Sanitation is intended to reduce the spread and burden of diseases transmitted from excreta. Pathogen reduction from excreta before sludge or effluent discharge to the environment would seem a logical and useful performance indicator for sanitation systems. However, the relative magnitudes of pathogen release from common sanitation technologies are not well understood. We, therefore, investigated the feasibility of performance measurement of different sanitation technologies in Tamil Nadu, India in reducing the release of the pathogen indicator Escherichia coli (E. coli). After conducting users’ surveys and technical assessments of the locally prevalent sanitation systems, we classified them into 7 distinct categories (based on both observed physical characteristic and usage) within a widely-accepted physical typology. Faecal sludge and wastewater samples were collected and analysed for E. coli and total solids from 136 household systems, 24 community systems, and 23 sanitary sewer oveflows. We estimated the average volumetric release rates of wastewater and faecal sludge from the different sanitation technologies. Average daily per capita E. coli release was computed, and used as one indicator of the public health performance of technologies. We found that on-site installations described by owners as “septic systems” included diverse forms of tanks and pits of uncertain performance. We observed a statistically significant difference in the average daily per capita E. coli release from different sanitation technologies (p = 0.00001). Pathogen release from the studied on-site sanitation technologies varied by as much as 5 orders of magnitude from “lined pits” (5.4 Log10 E. coli per person per day) to “overflowing sanitary sewers” and “direct discharge pipes” (10.3-10.5 Log10 E. coli per person per day). Other technologies lay between these extremes, and their performances in E. coli removal also varied significantly, in both statistical and practical terms. Our results suggest that although faecal sludge management along the sanitation service chain is important, sanitation planners of the observed systems (and probably elsewhere) should direct higher priority to proper management of the liquid effluents from these systems to minimize public health hazards. We conclude that (i) the work demonstrates a new and promising approach for estimating the public health performance of differing sanitation technologies, (ii) if E.coli is accepted as an indicator of the public health hazard of releases from sanitation systems, our results strongly suggest that safe containment of excreta for an extended period substantially reduces pathogen numbers and the risk of pathogen release into the environment; and (iii) there are some simple but little-used technical improvements to design and construction of on-site sanitation systems which could significantly reduce the release of pathogens to the environment.

PMID:35623255 | DOI:10.1016/j.ijheh.2022.113987

Am J Otolaryngol. 2022 May 19;43(4):103508. doi: 10.1016/j.amjoto.2022.103508. Online ahead of print.

ABSTRACT

INTRODUCTION: Radiofrequency ablation (RFA) has gained significant recent global interest in the treatment of benign thyroid nodules and thyroid cancer. It is a relatively new, minimally invasive, thermal ablation technique that is an alternative to surgery. Several clinical practice guidelines (CPGs), consensus statements, and recommendations currently exist for the use of RFA in the treatment of benign thyroid nodules and thyroid cancers. These documents have considerable variability amongst them, and to date, their quality and methodologic rigor have not been appraised.

OBJECTIVE: To identify and perform a quality appraisal of clinical practice guidelines for RFA in the treatment of benign thyroid nodules and thyroid cancer using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool.

METHODS: A comprehensive literature search was performed in MEDLINE (via PubMed), EMBASE, and SCOPUS databases from inception to November 1, 2021. Four reviewers independently evaluated each guideline using the AGREE II instrument. Scaled domain scores were generated and the threshold used for satisfactory quality was >60%. Additionally, intraclass correlation coefficients (ICCs) were calculated to determine level of agreement between reviewers.

RESULTS: Seven guidelines were selected for final evaluation based on inclusion/exclusion criteria. Two guidelines were classified “high” quality, one “average” quality, and the rest “low” quality. The “Clarity and Presentation” (65.68 ± 26.1) and “Editorial Independence” (61.32 ± 25.8) domains received the highest mean scores, while the “Applicability” (32.14 ± 22.8) and “Rigor of Development” (45.02 ± 29.8) domains received the lowest mean scores. ICC statistical analysis showed high magnitude of agreement between reviewers with a range of (0.722-0.944).

CONCLUSION: Reflecting upon our quality appraisal, it is evident that the quality and methodologic rigor of RFA guidelines can be improved upon in the future. Our findings also elucidate the existing variability/discrepancies amongst guidelines in the indications and use of RFA.

PMID:35623244 | DOI:10.1016/j.amjoto.2022.103508

J Infect Public Health. 2022 May 18;15(6):677-684. doi: 10.1016/j.jiph.2022.05.007. Online ahead of print.

ABSTRACT

BACKGROUND: Antibiotic-resistant Acinetobacter baumannii is a continuously-emerging worldwide health crisis, with mortality rates approaching 50% in intensive care unit (ICU) patients. The objective of this study was to evaluate regional, patient-related, and organism-related predictors of survival among critically-ill patients with confirmed Acinetobacter infection.

METHODS: This prospective cohort study was conducted within ten ICUs across six geographically- and climatologically-distinct cities across Saudi Arabia over 13 months.

RESULTS: Of 169 patients with confirmed Acinetobacter infection enrolled in the study, 80 (47.6%) died. Survivors were statistically younger, predominantly male, more likely to be admitted for trauma, less likely to have hypertension, diabetes, or have undergone hemodialysis, and more likely to have been treated with antibiotics prior to having a positive culture for Acinetobacter, but less likely to have received an aminoglycoside. Survivors also had lower baseline APACHE II and SOFA scores and were infected with stains of Acinetobacter that had less meropenem- or colistin-resistance. Multivariate analysis identified the following independent predictors of survival: younger age, lower ICU-day#1 APACHE-II and ICU-day#3 SOFA scores, being admitted for trauma, and having no history of hemodialysis.

CONCLUSIONS: Patient-related factors outweigh regional and hospital-related factors as predictors of survival among critically-ill patients with Acinetobacter infection.

PMID:35623242 | DOI:10.1016/j.jiph.2022.05.007

Comput Methods Programs Biomed. 2022 May 21;221:106900. doi: 10.1016/j.cmpb.2022.106900. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Multiple Sclerosis (MS) is a neurological disease associated with various and heterogeneous clinical characteristics. Given its complex nature and its unpredictable evolution over time, there isn’t an established and exhaustive clinical protocol (or tool) for its diagnosis nor for monitoring its progression. Instead, different clinical exams and physical/psychological evaluations need to be taken into account. The Expanded Disability Status Scale (EDSS) is the most used clinical scale, but it suffers from several limitations. Developing computational solutions for the identification of bio-markers of disease progression that overcome the downsides of currently used scales is crucial and is gaining interest in current literature and research.

METHODS: This Review focuses on the importance of approaching MS diagnosis and monitoring by investigating correlations between cognitive impairment and clinical data that refer to different MS domains. We review papers that integrate heterogeneous data and analyse them with statistical methods to understand their applicability into more advanced computational tools. Particular attention is paid to the impact that computational approaches can have on personalized-medicine.

RESULTS: Personalized medicine for neuro-degenerative diseases is an unmet clinical need which can be addressed using computational approaches able to efficiently integrate heterogeneous clinical data extracted from both private and publicly available electronic health databases.

CONCLUSIONS: Reliable and explainable Artificial Intelligence are computational approaches required to understand the complex and demonstrated interactions between MS manifestations as well as to provide reliable predictions on the disease evolution, representing a promising research field.

PMID:35623208 | DOI:10.1016/j.cmpb.2022.106900

Nurse Educ Pract. 2022 May 22;63:103370. doi: 10.1016/j.nepr.2022.103370. Online ahead of print.

ABSTRACT

AIM: The purpose of this paper is to describe an innovative educational approach for pre-licensure nursing students to learn and practice motivational interviewing skills in a telehealth simulation with standardized patients portraying pregnant women with substance use disorder.

BACKGROUND: Given the ongoing need for online delivery of both nursing education and clinical practice, providers must continue to find approaches to facilitate the provision of empathetic and personalized care to achieve optimal patient outcomes. Motivational interviewing integrates a person-centered approach with specific communication strategies to encourage and support patients’ commitment to change. Motivational interviewing skills can be implemented across a wide variety of patient situations, including mental health and primary nursing care.

DESIGN: The study followed a pre-/post-test cross-sectional observational design.

METHODS: After completing an online training course to learn motivational interviewing skills, students participated in an online simulation with a standardized patient portraying a woman with substance use disorder during pregnancy. Prior to the simulation, students completed the Caring Behaviors Inventory-24 and the Opening Minds Scale for Health Care Providers. After the simulation, students and standardized patients completed the Simulated Clinical Interview Rating Scale and a 5-item version of the Caring Behaviors Inventory-6.

RESULTS: Of the 252 students in the course, 85 (34%) participated in the study. Twenty-six student participants completed both pre- and post-simulation questionnaires; 40 completed only pre-simulation questionnaires; and 19 completed only post-simulation questionnaires. Prior to the simulated patient encounter, students rated themselves most favorably on ability to demonstrate assurance behaviors. After the training and simulation, students and standardized patients reported successful student demonstration of motivational interviewing skills and caring behaviors consistent with fundamental therapeutic communication and motivational interviewing knowledge. There was no statistically significant difference between self-reported student performance and the standardized patients’ observations.

CONCLUSIONS: Students attained and applied motivational skills and demonstrated caring behaviors in a virtual setting with standardized patients.

PMID:35623234 | DOI:10.1016/j.nepr.2022.103370

Am J Emerg Med. 2022 May 12;58:9-15. doi: 10.1016/j.ajem.2022.05.008. Online ahead of print.

ABSTRACT

BACKGROUND: Acute head and neck cancer (HNC) bleeding is a life-threatening situation that frequently presents to the emergency department (ED). The purpose of the present study was to analyze the risk factors for the 30-day mortality in patients with HNC bleeding.

METHODS: We included patients who presented to the ED with HNC bleeding (n = 241). Patients were divided into the survivor and nonsurvivor groups. Variables were compared, and the associated factors were examined with Cox’s proportional hazard model.

RESULTS: Of the 241 patients enrolled, the most common bleeding site was the oral cavity (n = 101, 41.9%). More than half of the patients had advanced HNC stage while 41.5% had local recurrence. The proportion of active bleeding was significantly higher in the nonsurvivor group (70.5% vs. 53.3%, p = 0.038). 42.3% received blood transfusion and 5.0% required inotropic support. In total, 21.2% of the patients experienced rebleeding, and 18.3% died within 30 days. Multivariate analyses indicated that a heart rate > 100 (beats/min) (HR = 2.42; Cl 1.15-5.06; p = 0.019) and inotropic support (HR = 3.00; Cl 1.14-7.89; p = 0.026) were statistically significant independent risk factors for 30-day mortality.

CONCLUSIONS: The results of this study may aid physicians in the evaluation of short-term survival in HNC bleeding patients and provide critical information for risk stratification and medical decisions.

PMID:35623184 | DOI:10.1016/j.ajem.2022.05.008

Eur J Obstet Gynecol Reprod Biol. 2022 May 20;274:88-95. doi: 10.1016/j.ejogrb.2022.05.012. Online ahead of print.

ABSTRACT

OBJECTIVE: Spontaneous preterm birth is the leading cause of infant morbidity and mortality in the developed world. Environmental socio-economic factors, such as neighborhood deprivation, are known to negatively affect birth outcomes, including overall preterm birth. However, the role of neighborhood deprivation in spontaneous preterm birth (SPTB) is unclear. The aim of the study is to 1) to determine the effect of neighborhood deprivation on SPTB birth and 2) to investigate the trend in rates of SPTB between 2010 and 2019 for each quintile of neighborhood deprivation.

STUDY DESIGN: Based on the national perinatal registry, we included 1,584,225 singleton pregnancies resulting in a birth from 22 to 42 completed weeks of gestation between 2010 and 2019 in the Netherlands. Deprivation scores per neighborhood were derived from the Netherlands Institute of Social Research and were linked to the perinatal registry data, using the woman’s home address. The scores were divided into quintiles (Q). Rates of SPTB were calculated, categorized into <37 weeks, <32 weeks and <28 weeks of gestation. We used logistic regression analysis to adjust for maternal age, parity and ethnicity.

RESULTS: Compared to the most affluent neighborhoods (Q1), women in all other quintiles had a statistically significant increased risk for SPTB. The largest effect was observed in the most deprived neighborhoods (Q5); adjusted odds ratio 1.16 (95% confidence interval 1.13 – 1.19). From 2010 to 2019, we observed an overall decrease of 0.21% in SPTB < 37 weeks (p < 0.0001). All quintiles showed a decrease in SPTBs < 37 weeks, but only in Q1, Q2 & Q5 this decline in SPTB was statistically significant.

CONCLUSIONS: Pregnant women in deprived neighborhoods in the Netherlands are more at risk for spontaneous preterm birth. From 2010 to 2019, the rate of spontaneous preterm birth decreased. Efforts should be made by both governmental and medical professionals to develop intervention programs to reduce spontaneous preterm birth in more deprived neighborhoods.

PMID:35623155 | DOI:10.1016/j.ejogrb.2022.05.012

Int J Nurs Stud. 2022 Apr 22;132:104259. doi: 10.1016/j.ijnurstu.2022.104259. Online ahead of print.

ABSTRACT

BACKGROUND: Elderspeak communication is typically viewed as patronizing and infantilizing by older adults and can lead to resistive behaviors in persons living with dementia. Little is known about the presence of elderspeak communication in hospitals in the United States. Understanding this phenomenon in the hospital setting is needed in order to improve hospital dementia care.

OBJECTIVES: The purpose of the Nurse Talk study was to (1) describe attributes of elderspeak use in hospital dementia care and to (2) determine what characteristics are associated with nursing staff use of elderspeak communication with hospitalized patients with dementia.

DESIGN: A cross-sectional observational study design was used to collect and analyze audio-recordings of nursing staff during care for hospitalized patients with dementia.

SETTING: Three hospital units in one Midwestern university hospital in the United States.

PARTICIPANTS: A convenience sample of 53 staff nurses and nursing assistants that provided direct care to 16 patients with mild or more severe dementia recruited from October 2019 through mid-March 2020.

METHODS: Eighty-eight care encounters were audio-recorded and coded for elderspeak communication using the Iowa Coding of Elderspeak scheme to determine the frequency and characteristics of elderspeak communication. A linear mixed effects model was used to determine what characteristics were associated with elderspeak and the frequency of elderspeak use by nursing staff to hospitalized patients with dementia.

RESULTS: Over a quarter (28.7%) of all nursing staff speech directed towards patients with dementia constituted elderspeak and nearly all (96.6%) care encounters included some elderspeak. Particularly common attributes of elderspeak were minimizing words and mitigating expressions, childish terms and phrases, and collective pronoun substitution. A statistically significant interaction was identified between staff role and age (95% CI: -0.02, -0.00, p = .008) in predicting the frequency of elderspeak use, indicating that elderspeak was used more often by older staff nurses, whereas the age of nursing assistants remained constant across elderspeak use. Statically significant effects for delirium and length of stay were also demonstrated. Elderspeak use was 12.5% higher with patients with delirium (95% CI: 0.02, 0.23, p = .025) and increased 1.5% for each additional day the patient with dementia was hospitalized (95% CI: 0.00, 0.03, p = .035).

CONCLUSIONS: Elderspeak is present and pervasive in the acute care setting. Interventions targeted towards older staff nurses and nursing staff from hospital units that care for patients with delirium and longer lengths of stay are needed.

TWEETABLE ABSTRACT: This study identified that nursing staff are frequently using elderspeak (infantilizing speech) with hospitalized patients with dementia. @claireshaw_phd @IowaNursing.

PMID:35623154 | DOI:10.1016/j.ijnurstu.2022.104259

Int J Nurs Stud. 2022 Apr 20;132:104255. doi: 10.1016/j.ijnurstu.2022.104255. Online ahead of print.

ABSTRACT

BACKGROUND: Insufficient self-care behaviors, low self-efficacy, depression, and poor illness perceptions are obstacles to the management of people with heart failure, leading to adverse patient outcomes. Self-care interventions are strategies used to support individuals in self-care. Currently, evidence on the effects of nurse-led self-care interventions on self-care behaviors and the correlates (self-efficacy, depression, and illness perceptions) in people with heart failure is scarce.

OBJECTIVES: This review aims to systematically synthesize current evidence to determine the effectiveness of nurse-led self-care interventions on self-care behaviors, self-efficacy, depression, and illness perceptions among people with heart failure and identify the optimal characteristics of effective nurse-led heart failure self-care programs.

METHODS: MEDLINE, Embase, Web of Science, CENTRAL, CINAHL, and PsycINFO were electrically searched for relevant articles from the inception to December 2021. Randomized controlled trials examining the effects of nurse-led self-care interventions on self-care behaviors, self-efficacy, depression, and illness perceptions among people with heart failure published in the English language were included. The quality appraisal of included studies was performed using the revised Cochrane tool for assessment of the risk of bias in randomized controlled trials (RoB 2.0). The meta-analysis was conducted using statistical software R. The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS: Twenty-four trials with 2488 participants were identified in this review. The results of our study revealed that nurse-led self-care interventions improved self-care maintenance (mean difference [MD]: 9.58, 95% confidence interval [CI]: 5.96 to 13.20, moderate certainty of evidence), self-care management (MD: 12.08, 95% CI: 8.05 to 16.11, high certainty of evidence), self-efficacy (standardized mean difference [SMD]: 0.98, 95% CI: 0.42 to 1.54, moderate certainty of evidence), and depression (SMD: 0.55, 95% CI: 0.34 to 0.77, high certainty of evidence) among people with heart failure. Moreover, subgroup analyses indicated that the ideal intervention duration to enhance self-care behaviors and self-efficacy was 1 to 3 months and to reduce depression was within 1 month.

CONCLUSIONS: This review revealed the beneficial effects of the nurse-led self-care interventions on self-care behaviors, self-efficacy, and depression among people with heart failure. The duration of the intervention is one of the factors that may affect the intervention effects. Further well-designed randomized controlled trials are recommended to strengthen the current evidence. Registration number (PROSPERO): CRD42022299754.

PMID:35623153 | DOI:10.1016/j.ijnurstu.2022.104255

Acta Psychol (Amst). 2022 May 24;227:103620. doi: 10.1016/j.actpsy.2022.103620. Online ahead of print.

ABSTRACT

This study aimed to confirm the status of body image perception by adolescents in South Korea and identify the associated factors using the data from the 14th Korea Youth Risk Behavior Survey (KYRBS) conducted in 2018. The KYRBS is a government-approved statistical survey performed annually and an anonymous self-administered online survey conducted in middle and high school students. The data for this study were downloaded from the KYRBS web site and analyzed through complex sample analysis. Body image distortion was found in 40.3% (under-perception 26.5%, over-perception 13.8%) of the boys and 39.7% (under-perception 14.4%, over-perception 25.3%) of the girls. The factors associated with body image distortion were school achievement, weight control, school, school type and exercise in school gym class in boys and school achievement, weight control, and economic status in girls. These results indicated that intervention programs for the accurate perception of body image should be provided to adolescents and these programs should consider gender difference in factors associated with adolescents’ body image distortion.

PMID:35623123 | DOI:10.1016/j.actpsy.2022.103620