Tag: nevin manimala

BMC Med. 2022 May 26;20(1):186. doi: 10.1186/s12916-022-02382-5.

ABSTRACT

BACKGROUND: There is limited knowledge regarding the process of deprescribing psychotropic drugs to people with dementia (PwD) conducted by general practitioners (GP). We investigated the impact of a multicomponent intervention, emphasizing medication reviews, on psychotropic drugs and behavioral and psychological symptoms (BPSD) in home-dwelling PwD and quantified change in patient-GP communication evaluated by their informal caregivers.

METHODS: [email protected] is a stepped-wedge closed-cohort cluster randomized controlled trial for people with mild to moderate dementia aged ≥65 and their informal caregivers (dyads) in Norway. Complementary to health care as usual (control condition), municipal coordinators implemented the multicomponent LIVE intervention: Learning, Innovation, Volunteer support, and Empowerment (including medication review by the PwD’s regular GPs). Block-randomization was used to allocate dyads in three groups receiving the intervention sequentially in periods of 6 months duration. Prepandemic data from the first period is reported, resulting in a 1:2 intervention-to-control ratio. Primary outcome was change in psychotropic drug use. Secondary outcomes were changes in BPSD by Neuropsychiatric Inventory and Cornell Scale of Depression in Dementia and patient-GP communication by an adaption of the Clinical Global Impression of Change.

RESULTS: Four hundred thirty-eight dyads were screened, 280 included, and 237 participated at 6 months (intervention group n=67; control condition n=170). At baseline, 63% used psychotropic medication regularly: antidementia drugs (47%), antidepressants (13%), hypnotics/sedatives (13%), antipsychotics (5%), and anxiolytics (2%). At 6 months, medication reviews were more frequently conducted in the intervention group compared to control (66% vs 42%, P=0.001). We found no differences regarding a change in drug use and BPSD. Patient-GP communication enhanced in the intervention group (mean score 0.95 [standard deviation 1.68] vs 0.41 [1.34], P=0.022). In the intervention group, control group, and overall sample, the informal caregivers of those who had their medications reviewed reported improved patient-GP communication compared to those who did not.

CONCLUSIONS: Change in psychotropic drug use and BPSD did not differ, even though patient-GP communication improved with medication reviews. Restricted psychotropic drug use among PwD likely reflects more judicious prescribing practices in recent years. Nevertheless, medication reviews could be cultivated to optimize pharmacologic treatment for this complex population.

TRIAL REGISTRATION: ClinicalTrials.gov : NCT04043364 ; registered 15/03/2019.

PMID:35614509 | DOI:10.1186/s12916-022-02382-5

BMC Med Educ. 2022 May 25;22(1):402. doi: 10.1186/s12909-022-03462-z.

ABSTRACT

BACKGROUND: This pilot study aimed to investigate the effects of developing scenario learning (DSL) on team efficacy, systems thinking, and proactivity in problem-solving in a fundamental nursing course.

METHODS: A total of 53 second-year nursing students were enrolled in the study; the DSL nursing education program was implemented for 15 weeks from March 4 to June 17, 2021. Data on team efficacy, systems thinking, and proactivity in problem-solving were measured before and after the DSL-based nursing education program. The collected data were analyzed using the IBM SPSS Statistics version 22.0.

RESULTS: The results demonstrated that nursing students’ team efficacy (t = – 8.228, p < .001, Cohen’s d = 1.079), systems thinking (t = – 9.757, p < .001, Cohen’s d = .731), and proactivity in problem-solving (t = – 8.635, p < .001, Cohen’s d = .992) significantly increased after the program.

CONCLUSIONS: The findings of this study can contribute to the development of nursing competency in nursing students without experience in nursing practicum. The authors recommend incorporating DSL in the nursing curriculum to promote early adaptation in clinical settings.

PMID:35614507 | DOI:10.1186/s12909-022-03462-z

BMC Nurs. 2022 May 25;21(1):128. doi: 10.1186/s12912-022-00915-0.

ABSTRACT

BACKGROUND: With the COVID-19 outbreak in China, the Chinese government took measures to prevent and control the spread of the virus. In-person teaching was replaced by distance learning, which was an unknown challenge for students. In this context, little is known about the perceived distress of nursing students and the relationship between psychological capital, perceived distress, and psychological stress. This study examined the relationship between psychological capital, psychological distress, and perceived stress, and the mediating role of psychological capital in the relationship between perceived stress and psychological distress among nursing students.

METHODS: This cross-sectional survey was conducted between January and December 2020 using a convenience sampling method involving 359 undergraduate and specialist nursing students at a tertiary hospital in Shandong Province. Standardised instruments were used to measure psychological capital, psychological stress, and perceived stress. We used SPSS 24.0 and PROCESS macro to analyse the data.

RESULTS: There was a statistically significant difference in perceived stress among students based on whether they liked the nursing profession (P < 0.01). Relative to nursing college students, undergraduates experienced significantly higher levels of perceived stress (P < 0.01). Nevertheless, there were no significant differences in perceived stress according to gender, place of residence, and being an only child. Psychological distress was positively correlated (r = 0.632, p < 0.001) with perceived stress (r =-0.662, p < 0.001), whereas it was negatively correlated with psychological capital. Psychological capital played a potential mediating role in the relationship between psychological distress and perceived stress.

CONCLUSIONS: Psychological distress was negatively correlated with psychological capital, and positively correlated with perceived stress. Mediation analyses indicated that psychological capital partially mediated the relationship between perceived stress and psychological distress. Educators should therefore heed students’ perceived stress and develop appropriate mental health counselling programmes for students in the curriculum that could help them reduce their psychological distress. In clinical practice, nursing managers must take effective measures, such as skills training, to improve the psychological capital of nursing students and reduce the negative impact of their psychological distress.

PMID:35614502 | DOI:10.1186/s12912-022-00915-0

Arthritis Res Ther. 2022 May 25;24(1):124. doi: 10.1186/s13075-022-02808-8.

ABSTRACT

INTRODUCTION: Foot involvement is a significant concern in psoriatic arthritis (PsA) as it can lead to severe levels of foot pain and disability and reduced mobility and quality of life. Previous studies have shown moderate efficacy for custom-made foot orthoses (CFO) in reducing foot pain and disability in people with rheumatoid arthritis. However, evidence on the efficacy of CFO in people with PsA is lacking.

OBJECTIVES: To explore the effects of CFO on foot function, foot and lower limb pain, gait function, and free-living walking activities (FWA) in people with PsA.

METHODS: A pre-experimental study including twenty participants with PsA (mean age: 54.10 ± 9.06 years and disease duration: 11.53 ± 10.22 years) was carried out. All the participants received and wore CFO for 7 weeks. Foot and lower limb pain and foot function were measured before and after the intervention using the numerical rating scale (NRS) and the foot function index (FFI). Gait function was assessed by recording spatiotemporal parameters (STPs) during a 10-m walk test using an instrumented gait analysis system (Mobility Lab). Free-living walking activities (step count, free-living cadence, time spent in different ambulatory physical activities (APA)) were recorded over 7 days using an accelerometer-instrumented sock.

RESULTS: The FFI reported scores demonstrated severe baseline levels of foot pain (54.46 ± 14.58 %) and disability (46.65 ± 16.14%). Statistically and clinically significant improvements in foot pain and foot function and large effect sizes (Cohen’s effect size > 1, p < 0.005) were observed after the intervention period. A strong correlation (r = -0.64, p < 0.01) between the CFO wearing time and foot function was demonstrated. However, no significant changes were found for gait STP or free-living walking activities after 7 weeks of CFO use.

CONCLUSION: Results support the clinical and biomechanical plausibility of using CFO in people with PsA to reduce pain and improve foot function. Large-scale and controlled studies are needed to confirm these findings. Moreover, a multidisciplinary approach including the prescription of exercise therapy and physiotherapy combined with CFO could be required to improve STP and promote APA in people with PsA.

TRIAL REGISTRATION: ClinicalTrials.gov , NCT05075343 . Retrospectively registered on September 29, 2021.

PMID:35614481 | DOI:10.1186/s13075-022-02808-8

BMC Womens Health. 2022 May 25;22(1):192. doi: 10.1186/s12905-022-01779-x.

ABSTRACT

OBJECTIVES: This study aimed to investigate awareness of women living in the western region of Iran about warning signs and risk factors for ovarian cancer.

METHODS: This cross-sectional, descriptive-analytical study was conducted in Sanandaj and Kermanshah, Iran, 2020 and 2021. In this study, 1081 women aged 18-70 years were selected as the sample to fill out the electronic version of the Ovarian Cancer Awareness Measure (OCAM) to identify the significant variables of ovarian cancer warning signs and risk factors. The obtained data were statistically analyzed by descriptive statistics and ordinal logistic regression in SPSS 19.

RESULTS: In this study, 60.9% of the participants had medium awareness of the subject. The results indicated that participants with higher educational attainment (P < 0.05) and those with a history of cancer (P < 0.001) showed higher knowledge of cancer. The lowest level of awareness of symptoms was associated with acute symptoms such as dysphagia (swallowing problems) most days, persistent bloating, a sense of abdominal fullness or heaviness, and frequent urination. Moreover, the lowest awareness of risk factors was related to the history of IVF treatments and the application of talcum powder to the genital area.

CONCLUSION: The study findings showed that women living in the western region of Iran have moderate awareness of ovarian cancer and insufficient knowledge of cancer warning signs; this suggests that it is necessary to train Iranian women to raise awareness of the signs and risk factors for ovarian cancer.

PMID:35614471 | DOI:10.1186/s12905-022-01779-x

Environ Health. 2022 May 25;21(1):57. doi: 10.1186/s12940-022-00862-y.

ABSTRACT

BACKGROUND: Studies focusing on dietary pesticides in population-based samples are scarce and little is known about potential mixture effects. We aimed to assess associations between dietary pesticide exposure profiles and Type 2 Diabetes (T2D) among NutriNet-Santé cohort participants.

METHODS: Participants completed a Food Frequency Questionnaire at baseline, assessing conventional and organic food consumption. Exposures to 25 active substances used in European Union pesticides were estimated using the Chemisches und Veterinäruntersuchungsamt Stuttgart residue database accounting for farming practices. T2D were identified through several sources. Exposure profiles were established using Non-Negative Matrix Factorization (NMF), adapted for sparse data. Cox models adjusted for known confounders were used to estimate hazard ratios (HR) and 95% confidence interval (95% CI), for the associations between four NMF components, divided into quintiles (Q) and T2D risk.

RESULTS: The sample comprised 33,013 participants aged 53 years old on average, including 76% of women. During follow-up (median: 5.95 years), 340 incident T2D cases were diagnosed. Positive associations were detected between NMF component 1 (reflecting highest exposure to several synthetic pesticides) and T2D risk on the whole sample: HR_Q5vsQ1 = 1.47, 95% CI (1.00, 2.18). NMF Component 3 (reflecting low exposure to several synthetic pesticides) was associated with a decrease in T2D risk, among those with high dietary quality only (high adherence to French dietary guidelines, including high plant foods consumption): HR_Q5vsQ1 = 0.31, 95% CI (0.10, 0.94).

CONCLUSIONS: These findings suggest a role of dietary pesticide exposure in T2D risk, with different effects depending on which types of pesticide mixture participants are exposed to. These associations need to be confirmed in other types of studies and settings, and could have important implications for developing prevention strategies (regulation, dietary guidelines).

TRIAL REGISTRATION: This study is registered in ClinicalTrials.gov ( NCT03335644 ).

PMID:35614475 | DOI:10.1186/s12940-022-00862-y

BMC Med Res Methodol. 2022 May 25;22(1):150. doi: 10.1186/s12874-022-01616-7.

ABSTRACT

BACKGROUND: The major drivers of cost-effectiveness for chronic obstructive pulmonary disease (COPD) therapies are the occurrence of exacerbations and deaths. Exacerbations, including acute and long-term events, can cause worsening of COPD and lead to an increased risk of further exacerbations, and ultimately may elevate the risk of death. In contrast to this, health economic models are based on COPD severity progression. In this post hoc analysis of the ETHOS study, we focus on the progression of COPD due to exacerbations and deaths.

METHODS: We fitted semi-parametric and fully parametric multi-state Markov models with the following five progressive states: State 1, no exacerbation; State 2, 1 moderate exacerbation; State 3, ≥ 2 moderate exacerbations; State 4, ≥ 1 severe exacerbations; State 5, death. The models only allowed a patient to transition to a worsened health state, and transitions did not necessarily have to be to the next adjacent state. We used the multi-state models to analyse data from ETHOS, a phase III, 52-week study assessing the efficacy and safety of triple therapy with budesonide/glycopyrronium/formoterol fumarate dihydrate in moderate-to-very severe COPD.

RESULTS: The Weibull multi-state Markov model showed good fit of the data. In line with clinical evidence, we found a higher mortality risk after a severe exacerbation (11.4-fold relative ratio increase [95% CI, 7.7-17.0], 6.4-fold increase [95% CI, 3.8-10.8] and 5.4-fold increase [95% CI, 2.9-10.3] relative to no exacerbations, 1 moderate exacerbation or ≥ 2 moderate exacerbations, respectively). One moderate exacerbation increased mortality risk 1.8-fold (95% CI, 1.1-2.9) vs no exacerbations. We also found a higher risk of severe exacerbation and mortality following ≥ 2 moderate exacerbations.

CONCLUSION: Multi-state modelling of patients with COPD in ETHOS found an acute and chronic effect of severe exacerbations on mortality risk. Risk was also increased after a moderate exacerbation. Clinical management with effective pharmacotherapies should be optimised to avoid even moderate exacerbations. Modelling with exacerbations could be an alternative to current COPD models focused on disease progression.

TRIAL REGISTRATION: NCT02465567.

PMID:35614467 | DOI:10.1186/s12874-022-01616-7

Mov Ecol. 2022 May 25;10(1):26. doi: 10.1186/s40462-022-00322-9.

ABSTRACT

Movement is fundamental to life, shaping population dynamics, biodiversity patterns, and ecosystem structure. In 2008, the movement ecology framework (MEF Nathan et al. in PNAS 105(49):19052-19059, 2008) introduced an integrative theory of organismal movement-linking internal state, motion capacity, and navigation capacity to external factors-which has been recognized as a milestone in the field. Since then, the study of movement experienced a technological boom, which provided massive quantities of tracking data of both animal and human movement globally and at ever finer spatio-temporal resolutions. In this work, we provide a quantitative assessment of the state of research within the MEF, focusing on animal movement, including humans and invertebrates, and excluding movement of plants and microorganisms. Using a text mining approach, we digitally scanned the contents of [Formula: see text] papers from 2009 to 2018 available online, identified tools and methods used, and assessed linkages between all components of the MEF. Over the past decade, the publication rate has increased considerably, along with major technological changes, such as an increased use of GPS devices and accelerometers and a majority of studies now using the R software environment for statistical computing. However, animal movement research still largely focuses on the effect of environmental factors on movement, with motion and navigation continuing to receive little attention. A search of topics based on words featured in abstracts revealed a clustering of papers among marine and terrestrial realms, as well as applications and methods across taxa. We discuss the potential for technological and methodological advances in the field to lead to more integrated and interdisciplinary research and an increased exploration of key movement processes such as navigation, as well as the evolutionary, physiological, and life-history consequences of movement.

PMID:35614458 | DOI:10.1186/s40462-022-00322-9

BMC Womens Health. 2022 May 25;22(1):189. doi: 10.1186/s12905-022-01776-0.

ABSTRACT

BACKGROUND: Pregnancy is a time when women are making many changes, including the patterns of alcohol consumption. Alcohol consumption during pregnancy encourages the risks of mothers and unborn child. Alcohol use during pregnancy can result in prematurity, brain damage, growth restriction, developmental delay and social, emotional and behavioral deficits, particularly in developing countries.

METHODS: A community based cross-sectional study was employed. Structured questionnaires were used to assess the prevalence of alcohol utilization, and socio-demographic as well as economic characteristics of women who have pregnancy experience. Both bivariate and multivariate logistic regression models were employed. Descriptive and inferential statistical analyses were used.

RESULTS: The study results showed that the prevalence of alcohol use and response rate was high. Factors like age group of women from 35-49 years (AOR = 0.221; 95%CI = 0.057-0.856), illiterate women(AOR = 2.697;95% CI = 1.207-6.026), currently pregnant (AOR = 0.139;95%CI = 0.057 0.343), women currently use alcohol (AOR = 0.021; 95% CI = 0.009 0.049), alcohol use pre-pregnancy (AOR = 0.016; 95% CI = 0.006-0.042), women drinking alcohol with husband during pregnancy (AOR = 0.228; 95% CI = 0.085-0.614), the risk of alcohol consumption during pregnancy is low(AOR = 0.262;95%CI = 0.074-0.925), risk alcohol consumption during pregnancy is medium (AOR = 0.296;95% CI = 0.103-0.849),utilization of alcohol during pregnancy is valuable (AOR = 0.104; 95%CI = .0.013-0.833) were statistically associated with alcohol use during pregnancy.

CONCLUSION: The result inferred that there is a high level of alcohol use throughout pregnancy. Due to the differences in the culture and communal means of drinking alcohol, the frequency of alcohol consumption during pregnancy varies among different regional studies and countries.

PMID:35614455 | DOI:10.1186/s12905-022-01776-0

BMC Med Educ. 2022 May 25;22(1):400. doi: 10.1186/s12909-022-03475-8.

ABSTRACT

BACKGROUND: To ascertain if undergraduate medical students attain adequate knowledge to practice in paediatrics, we designed the minimum accepted competency (MAC) examination. This was a set of MCQ’s designed to test the most basic, ‘must know’ knowledge as determined by non-faculty paediatric clinicians. Only two-thirds of undergraduate students passed this exam, despite 96% of the same cohort passing their official university paediatric examination. We aim to describe the psychometric properties of the MAC examination to explore why there was a difference in student performance between these two assessments which should, in theory, be testing the same subject area. We will also investigate if the MAC examination is a potentially reliable method of assessing undergraduate knowledge.

METHODS: The MAC examination was sat by three groups of undergraduate medical students and paediatric trainee doctors. Test item analysis was performed using facility index, discrimination index and Cronbach’s alpha.

RESULTS: Test item difficulty on the MAC between each group was positively correlated. Correlation of item difficulty with the standard set for each item showed a statistically significant positive relationship. However, for 10 of the items, the mean score achieved by the candidates did not even reach two standard deviations below the standard set by the faculty. Medical students outperformed the trainee doctors on three items. 18 of 30 items achieved a discrimination index > 0.2. Cronbach’s alpha ranged from 0.22-0.59.

CONCLUSION: Despite faculty correctly judging that this would be a difficult paper for the candidates, there were a significant number of items on which students performed particularly badly. It is possible that the clinical emphasis in these non-faculty derived questions was juxtaposed with the factual recall often required for university examinations. The MAC examination highlights the difference in the level of knowledge expected of a junior doctor starting work in paediatrics between faculty and non-faculty clinicians and can identify gaps between the current curriculum and the ‘hidden curriculum’ required for real world clinical practice. The faculty comprises physicians in employment by the University whose role it is to design the paediatric curriculum and deliver teaching to undergraduate students. Non-faculty clinicians are paediatric physicians who work soley as clinicians with no affiliation to an educational institution. The concept of a MAC examination to test basic medical knowledge is feasible and the study presented is an encouraging first step towards this method of assessment.

PMID:35614439 | DOI:10.1186/s12909-022-03475-8