Tag: nevin manimala

West J Emerg Med. 2021 Jul 19;22(4):919-930. doi: 10.5811/westjem.2021.3.49770.

ABSTRACT

INTRODUCTION: The role of gender in interprofessional interactions is poorly understood. This mixed-methods study explored perceptions of gender bias in interactions between emergency medicine (EM) residents and nurses.

METHODS: We analyzed qualitative interviews and focus groups with residents and nurses from two hospitals for dominant themes. An electronic survey, developed through an inductive-deductive approach informed by qualitative data, was administered to EM residents and nurses. Quantitative analyses included descriptive statistics and between-group comparisons.

RESULTS: Six nurses and 14 residents participated in interviews and focus groups. Key qualitative themes included gender differences in interprofessional communication, specific examples of, and responses to, gender bias. Female nurses perceived female residents as more approachable and collaborative than male residents, while female residents perceived nurses’ questions as doubting their clinical judgment. A total of 134 individuals (32%) completed the survey. Females more frequently perceived interprofessional gender bias (mean 30.9; 95% confidence interval {CI}, 25.6, 36.2; vs 17.6 [95% CI, 10.3, 24.9). Residents reported witnessing interprofessional gender bias more frequently than nurses (58.7 (95% CI, 48.6, 68.7 vs 23.9 (95% CI, 19.4, 28.4). Residents reported that gender bias affected job satisfaction (P = 0.002), patient care (P = 0.001), wellness (P = 0.003), burnout (P = 0.002), and self-doubt (P = 0.017) more frequently than nurses.

CONCLUSION: Perceived interprofessional gender bias negatively impacts personal wellbeing and workplace satisfaction, particularly among female residents. Key institutional stakeholders including residency, nursing, and hospital leadership should invest the resources necessary to develop and integrate evidence-based strategies to improve interprofessional relationships that will ultimately enhance residency training, work climate, and patient care.

PMID:35353996 | DOI:10.5811/westjem.2021.3.49770

West J Emerg Med. 2021 Jul 20;22(4):882-889. doi: 10.5811/westjem.2021.2.50249.

ABSTRACT

INTRODUCTION: Increases in emergency department (ED) crowding and boarding are a nationwide issue resulting in worsening patient care and throughput. To compensate, ED administrators often look to modifying staffing models to improve efficiencies.

METHODS: This study evaluates the impact of implementing the waterfall model of physician staffing on door-to-doctor time (DDOC), door-to-disposition time (DDIS), left without being seen (LWBS) rate, elopement rate, and the number of patient sign-outs. We examined 9,082 pre-intervention ED visits and 8,983 post-intervention ED visits.

RESULTS: The change in DDOC, LWBS rate, and elopement rate demonstrated statistically significant improvement from a mean of 65.1 to 35 minutes (P <0.001), 1.12% to 0.92% (P = 0.004), and 3.96% to 1.95% (P <0.001), respectively. The change in DDIS from 312 to 324.7 minutes was not statistically significant (P = 0.310). The number of patient sign-outs increased after the implementation of a waterfall schedule (P <0.001).

CONCLUSION: Implementing a waterfall schedule improved DDOC time while decreasing the percentage of patients who LWBS and eloped. The DDIS and number of patient sign-outs appears to have increased post implementation, although this may have been confounded by the increase in patient volumes and ED boarding from the pre- to post-intervention period.

PMID:35353992 | DOI:10.5811/westjem.2021.2.50249

Sci Total Environ. 2022 Mar 27:154867. doi: 10.1016/j.scitotenv.2022.154867. Online ahead of print.

ABSTRACT

Climatology and trends in different types of aerosols with focus on absorbing aerosols over Kanpur located in Indo-Gangetic Plain (IGP) in South Asia and Beijing in North China Plain (NCP) in East Asia are investigated. We perform a first analysis of high-quality time series of columnar aerosols observations over a period of nearly two-decades, along with satellite observations to provide a broader regional perspective. Satellite retrieved aerosol Ångström exponent (AE) values have increased (10-20%) suggesting an increasing contribution of fine aerosols to aerosol optical depth (AOD) over Asia in last 2-decades. Among three aerosol types [urban-industrial (UI), biomass burning (BB), and dust (DU)], only UI and BB aerosols are present over Kanpur throughout the year, while DU is present along with UI and BB aerosols only during pre-monsoon and monsoon. Overall, there is a positive trend in BB aerosols over both Kanpur and Beijing, a positive (negative) trend in UI aerosols over Kanpur (Beijing), and positive (negative) trend in dust over Beijing (Kanpur). Positive trend in BB aerosols over Kanpur is statistically significant. Among three absorbing aerosol types [mostly black carbon (MBC), mostly dust (MDU), and mixed (MIX) containing BC and dust], only MBC and MIX are present in post-monsoon and winter over IGP, and MDU is present along with MBC and MIX only during pre-monsoon and monsoon, in agreement with aerosol types found. Trends in MBC, MIX and MDU over Kanpur in IGP and in MIX over Beijing are statistically significant. These trends are attributed mainly to changes in anthropogenic aerosol emissions, and not to natural and climatic factors as their changes are relatively small. These findings on hitherto unavailable climatology and trends in aerosols and absorbing aerosols over two global aerosol hotspots and identified contrasts will be crucial in model simulations to better decipher aerosol-climate interactions over Asia.

PMID:35353982 | DOI:10.1016/j.scitotenv.2022.154867

J Clin Lab Anal. 2022 Mar 30:e24379. doi: 10.1002/jcla.24379. Online ahead of print.

ABSTRACT

BACKGROUND: Mucosa-associated lymphoid tissue lymphoma translocation protein 1 (MALT1) participates in the immune-related allergic response and inflammation flare, while its clinical role in asthma children is still unknown. Herein, this study aimed to investigate MALT1 expression, and its correlation with exacerbation risk, T helper (Th)1, Th2 cells (and their secreted cytokines), as well as inflammatory cytokines in asthma children.

METHODS: Sixty children with asthma exacerbation and 60 children with remission asthma were enrolled in this study; then their blood MALT1, Th1, Th2 cells, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interferon-gamma (IFN-γ), and interleukin-4 (IL-4) were detected. Besides, blood MALT1 in another 20 health controls was also determined.

RESULTS: Mucosa-associated lymphoid tissue lymphoma translocation protein 1 was highest in children with asthma exacerbation, followed by children with remission asthma, and lowest in health controls (p < 0.001). MALT1 could distinguish children with asthma exacerbation from children with remission asthma (area under the curve (AUC): 0.757, 95% CI: 0.670-0.843). In children with asthma exacerbation, MALT1 was negatively linked with IFN-γ (p = 0.002) and Th1 cells (p = 0.050), but positively related to Th2 cells (p = 0.027) and exhibited a positive correlation trend (without statistical significance) with IL-4 (p = 0.066); meanwhile, MALT1 was positively correlated with exacerbation severity (p = 0.010) and TNF-α (p = 0.003), but not linked with IL-6 (p = 0.096). In children with remission asthma, MALT1 only was negatively associated with Th1 cells (p = 0.023), but positively linked with TNF-α (p = 0.023).

CONCLUSION: Mucosa-associated lymphoid tissue lymphoma translocation protein 1 serves as a potential biomarker for monitoring exacerbation risk and Th1/Th2 imbalance-mediated inflammation of asthma children.

PMID:35353938 | DOI:10.1002/jcla.24379

Ultrasound Obstet Gynecol. 2022 Mar 30. doi: 10.1002/uog.24906. Online ahead of print.

ABSTRACT

OBJECTIVES: To report the causative relationship of maternal COVID-19 with intrauterine fetal death, describe the specific placental pathology, findings of fetal autopsy and clinical characteristics, and identify potential risk factors.

METHODS: This is a prospective case series. A cohort of 165 placentas of non-vaccinated pregnant women affected by COVID-19 in Greece were histologically examined and six cases of intrauterine fetal death associated with SARS-COV-2 placentitis were retrieved. Complete fetal autopsy was performed in three cases. Gross, histopathological, immunohistochemical, molecular, and electron microscopy examinations were carried out in the stillbirth placentas and fetal organs. The histological findings of SARS-COV-2 placentitis were compared with the 159 cases, in which maternal COVID-19 resulted in livebirth. Regression analysis was used to identify predisposing factors for SARS-COV-2 placentitis.

RESULTS: All six stillbirth placentas showed severe and extensive histological changes of SARS-COV-2 placentitis, i.e. a combination of marked intervillositis with a mixed inflammatory infiltrate and massive perivillous fibrinoid deposition with trophoblast damage, associated with intensely positive immunostaining for SARS-COV-2 spike protein, the presence of virions on electron microscopy and a positive RT-PCR test in placental tissues. The histological lesions obliterated over 75% of the maternal intervillous space, accounting for intrauterine fetal death. Similar histological lesions affecting less than 25% of the placenta were recorded in 7 liveborn neonates, while the remaining 152 placentas of COVID-19-affected pregnancies with livebirths did not show similar findings. Complete fetal autopsy showed evidence of an asphyctic mode of death without evidence of viral transmission to the fetus. The mothers had mild clinical symptoms or were asymptomatic and the interval between maternal COVID-19 diagnosis and fetal death ranged from 3 to 15 days. Statistically significant predisposing factors for SARS-COV-2-placentitis included thrombophilia and IUGR. Multiple sclerosis was seen in one case.

CONCLUSIONS: SARS-COV-2 placentits occurred uncommonly in COVID-19-affected pregnancies of non-vaccinated mothers and, when extensive, caused fetal demise, with no evidence of transplacental fetal infection. Thrombophilia and prenatally detected IUGR emerged as independent predisposing factors for the potentially lethal SARS-COV-2 placentitis. This article is protected by copyright. All rights reserved.

PMID:35353936 | DOI:10.1002/uog.24906

Neurourol Urodyn. 2022 Mar 30. doi: 10.1002/nau.24913. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe the characteristics of women with stress or mixed urinary incontinence (SUI/MUI) receiving physical therapy (PT) services, including referral patterns and PT utilization.

METHODS: Female patients with claims associated with an SUI or MUI diagnosis (International Classification of Disease-Clinical Modification [ICD-9-CM]: 625.6, 788.33, or ICD-10-CM: N39.3, N39.46) between July 01, 2014 and June 30, 2016 were identified in International business machines (IBM)’s MarketScan Research Database. Inclusion criteria included the absence of pregnancy claims and ≥80% medical and pharmacy enrollment pre- and postindex. First SUI/MUI diagnosis claim determined index. Patients were followed for 2 years, and associated UI-associated PT encounters were identified. Descriptive statistics were calculated for patients with at least one PT visit during the postindex period.

RESULTS: In a cohort of 103,813 women with incident SUI or MUI diagnosis, 2.6% (2792/103,813) had at least one PT visit in the 2 years following their diagnosis. Mean age at index PT encounter was 50.55 years. A total of 52.36% (1462/2792) women had one to four PT visits; 21.2% (592/2792) had >8 PT visits. In subanalysis of the PT cohort (1345/2792), women who received PT only had the lowest average 2-year postindex total medical cost (mean: $12,671; SD: $16,346), compared with PT plus medications (mean: $27,394; SD: $64,481), and PT plus surgery (mean: $33,656; SD: $26,245), respectively. Over 40% had their first PT visit ≥3 months after their index date.

CONCLUSIONS: The percentage of women with a PT visit associated with an incident SUI or MUI diagnosis was low (2.6%), and 30% of this group completed three or more PT visits. This suggests poor adherence to clinical guidelines regarding supervised treatment of UI in women.

IMPACT STATEMENT: Our study suggests underutilization of PT among insured women with SUI and MUI in the 2 years following diagnosis. Interventions to improve this gap in first-line care may represent an opportunity for an increased role for PTs in the care of women with UI.

PMID:35353916 | DOI:10.1002/nau.24913

ALTEX. 2022 Mar 30. doi: 10.14573/altex.2012022. Online ahead of print.

ABSTRACT

Exposure-response assessment methods have shifted towards more quantitative approaches, with health risk assessors exploring more statistically driven techniques. These assessments, however, usually rely on one critical health effect from a single key study. Categorical regression addresses this limitation by incorporating data from all relevant studies – including human, animal, and mechanistic studies – thereby including a broad spectrum of health endpoints and exposure levels for exposure-response analysis in an objective manner. Categorical regression requires the establishment of ordered response categories corresponding to increasingly severe adverse health outcomes, and the availability of a comprehensive database that summarizes all data on different outcomes from different studies, including the exposure or dose at which these outcomes are observed and their severity. It has found application in the risk assessment of essential nutrients and trace metals. Since adverse effects may arise from either deficient or excess exposure, the exposure-response curve is U-shaped, which provides a basis for determining optimal intake levels that minimize the joint risks of deficiency and excess. This article provides an overview of the use of categorical regression fit exposure-response models incorporating data from multiple evidence streams. An extension of categorical regression that permits the simultaneous analysis of excess and deficiency toxicity data is presented and applied to comprehensive databases on copper and manganese. Future applications of categorical regression will be able to make greater use of diverse data sets developed using new approach methodologies, which can be expected to provide valuable information on toxic responses of varying severity.

PMID:35353900 | DOI:10.14573/altex.2012022

Psychophysiology. 2022 Mar 30:e14064. doi: 10.1111/psyp.14064. Online ahead of print.

ABSTRACT

Cardiovascular reactions to acute psychological stress have been associated with cognitive function. However, previous work has assessed cardiovascular reactions and cognitive function in the laboratory at the same time. The present study examined the association between cardiovascular reactions to acute psychological stress in the laboratory and academic performance in final year high school students. Heart rate, blood pressure, stroke volume, and cardiac output reactions to an acute psychological stress task were measured in 131 participants during their final year of high school. Performance on high school A-levels were obtained the following year. Higher heart rate and cardiac output reactivity were associated with better A-level performance. These associations were still statistically significant after adjusting for a wide range of potentially confounding variables. The present results are consistent with a body of literature suggesting that higher heart rate reactions to acute psychological stress are associated with better cognitive performance across a variety of domains.

PMID:35353904 | DOI:10.1111/psyp.14064

Mod Rheumatol. 2022 Mar 30:roac022. doi: 10.1093/mr/roac022. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the changes in knee pain, a dominant cause of physical disability, following the coronavirus disease (COVID-19) pandemic, and to identify factors affecting the changes in knee pain.

METHODS: We analyzed the pre- and post-COVID-19 longitudinal dataset of the Nagahama Study. Knee pain was assessed using the Knee Society Score (KSS). The estimated KSS from the age and sex using regression model in the pre- and post-COVID-19 dataset was compared. Factors including the activity score, educational level, and various impacts of COVID-19 were analyzed for correlation analyses with changes in KSS.

RESULTS: Data collected from 6409 participants showed statistically significant differences in KSS, pre- (mean = 22.0; SD = 4.4) and post-COVID-19 (mean = 19.5; SD = 6.4). Low activity score (p = 0.008), low educational level (p < 0.001) and undesirable financial impact (p = 0.030) were independently associated with knee pain exacerbation.

CONCLUSION: The harmful effects of the COVID-19 pandemic on knee pain were suggested. People should be encouraged to engage in physical activities, such as walking, even despite the state of emergency. Furthermore, social support for economically disadvantaged groups may improve healthcare access, preventing the acute exacerbations of knee pain.

PMID:35353896 | DOI:10.1093/mr/roac022