Tag: nevin manimala

J Surg Res. 2021 Oct 2;269:229-233. doi: 10.1016/j.jss.2021.08.022. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma patients may initially be evaluated at non-trauma centers. This may cause a delay in treatment, which could affect their outcome. Additionally, advanced imaging may be performed which may be suboptimal or unnecessary, increase time to transfer, or unable to be viewed when the patient reaches a trauma center increasing the delays to treatment or need for repeat imaging. Rapid identification and transfer to definitive trauma care, minimizing unnecessary delays should be the priority.

METHODS: The trauma registry at a regional Level 1 Adult/Pediatric Trauma center was queried for transferred trauma patients over a 3-y period. A retrospective review was performed. Transferred trauma patients were compared prior to an expedited transfer protocol to after implementation. Demographics, mechanism of injury, injury severity score, computerized tomography scans performed prior to transfer, mortality, hospital and intensive care unit length of stay were compared using bivariate and multivariable regression statistics where appropriate.

RESULTS: Transferred trauma patients were identified, 683 in the pre-protocol group and 821 in the post-protocol group, an increase of 16.8%. There were no differences in age, sex, injury severity score, mechanism of injury, mortality, hospital, or intensive care unit length of stay (LOS) throughout the study period. There was a significant decrease in time to transfer (263 min ± 222 versus 227 ± 189, P < 0.001) and computerized tomography scans performed prior to transfer (Head 47% versus 32%, C-spine 36% versus 23%, Thorax 22% versus 16%, Abdomen/Pelvis 24% versus 14%, all P values <0.001 except CT Thorax). Interestingly, the rate of underinsured patients did not increase (21% versus 25%, P = 0.05). Risk-adjusted mortality and hospital LOS also did not change during the study period.

CONCLUSIONS: After implementation of an expedited trauma transfer protocol to a regional Level 1 trauma center there was an associated reduced time of arrival to definitive care and decreased advanced imaging done prior to transfer. However, there was no associated decrease in mortality or LOS among transferred patients. Further studies examining prehospital transport or hospital choice decisions and subsequent care provided at non-trauma facilities regarding imaging obtained, care rendered, and transfer decisions can be explored.

PMID:34610536 | DOI:10.1016/j.jss.2021.08.022

Epidemics. 2021 Sep 25;37:100503. doi: 10.1016/j.epidem.2021.100503. Online ahead of print.

ABSTRACT

PCR testing is a crucial capability for managing disease outbreaks, but it is also a limited resource and must be used carefully to ensure the information gain from testing is valuable. Testing has two broad uses for informing public health policy, namely to track epidemic dynamics and to reduce transmission by identifying and managing cases. In this work we develop a modelling framework to examine the effects of test allocation in an epidemic, with a focus on using testing to minimise transmission. Using the COVID-19 pandemic as an example, we examine how the number of tests conducted per day relates to reduction in disease transmission, in the context of logistical constraints on the testing system. We show that if daily testing is above the routine capacity of a testing system, which can cause delays, then those delays can undermine efforts to reduce transmission through contact tracing and quarantine. This work highlights that the two goals of aiming to reduce transmission and aiming to identify all cases are different, and it is possible that focusing on one may undermine achieving the other. To develop an effective strategy, the goals must be clear and performance metrics must match the goals of the testing strategy. If metrics do not match the objectives of the strategy, then those metrics may incentivise actions that undermine achieving the objectives.

PMID:34610549 | DOI:10.1016/j.epidem.2021.100503

Nurse Educ Today. 2021 Sep 21;108:105123. doi: 10.1016/j.nedt.2021.105123. Online ahead of print.

ABSTRACT

BACKGROUND: Nurses, especially nurses in Africa, face barriers when trying to access and apply literature. These challenges include paywalls; complex academic language; and journal content which is hard to translate to local realities.

OBJECTIVES: To investigate nurses’ self-reported experiences of participating in a monthly hospital wide journal club at the Red Cross War Memorial Children’s Hospital (RCWMCH).

DESIGN: This descriptive study used a researcher-designed quantitative questionnaire design. The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guideline were used.

SETTING: Red Cross War Memorial Children’s Hospital (RCWMCH) in Cape Town, South Africa.

PARTICIPANTS: All cadres of nurses working at the Red Cross War Memorial Children’s Hospital (RCWMCH) who had attended six or more hospital journal club sessions at RCWMCH over the previous two years.

METHODS: A descriptive study using a researcher-designed quantitative questionnaire.

RESULTS: 155 participants completed the survey (96.87% response rate). Participants self-reported an improved knowledge of the main sections of a journal article (p < 0.001) and a significant increase in talking to colleagues about evidence-based nursing practice after attending journal club (p < 0.001).

CONCLUSIONS: Attendance at a journal club appears to contribute to increased access to scientific literature, personal and organisational habits of reading, and collaborative exploration of clinical practice for nurses of all cadres. Innovative facilitation methods (including large-scale graphic facilitation) may contribute to efficacy and popularity of sessions.

PMID:34610529 | DOI:10.1016/j.nedt.2021.105123

Biosens Bioelectron. 2021 Sep 22;195:113663. doi: 10.1016/j.bios.2021.113663. Online ahead of print.

ABSTRACT

Tuberculosis (TB) remains the high-risk infectious pathogen that caused global pandemic and high mortality, particularly in the areas lack in health resources. Clinical TB screening and diagnosis are so far mainly conducted on limited types of commercial platforms, which are expensive and require skilled personnel. In this work, we introduced a low-cost and portable finger-driven microfluidic chip (named Fd-MC) based on recombinase polymerase amplification (RPA) for rapid on-site detection of TB. After injection of the pre-treated sample solution, the pre-packaged buffer was driven by the pressure generated by the finger-actuated operation to accomplish sequential processes of diagnosis in a fully isolated microchannel. An in-situ fluorescence strategy based on FAM-probe was implemented for on-chip results read-out though a hand-held UV lamp. Hence, the Fd-MC proved unique advantageous for avoiding the risk of infection or environmental contamination. In addition, the Fd-MC was designed for multiplexed detection, which is able to not only identify TB/non-TB infection, but also differentiate between human Mycobacterium tuberculosis and Mycobacterium bovis. The platform was verified in 37 clinical samples, statistically with 100% specificity and 95.2% sensitivity as compared to commercial real-time RPA. Overall, the proposed platform eliminates the need on external pumps and skilled personnel, holding promise to POC testing in the resource-limited area.

PMID:34610534 | DOI:10.1016/j.bios.2021.113663

J Minim Invasive Gynecol. 2021 Oct 2:S1553-4650(21)01178-X. doi: 10.1016/j.jmig.2021.09.714. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE(S): In this study, we describe trends of all three routes of hysterectomy, patient demographics, and perioperative morbidity among women undergoing surgery for benign indications between 2007-2017. We also sought to compare the rates of ELOS and readmission rates among the laparoscopic, abdominal, and transvaginal routes.

STUDY DESIGN: Retrospective cohort study STUDY SETTING: National Database study PATIENTS: American College of Surgeons- National Surgical Quality Improvement Program (ACS-NSQIP) database to identify patients who underwent an elective hysterectomy for benign indication between 2007-2017.

INTERVENTIONS: Patients were identified using Current Procedural Terminology (CPT) codes and excluded if their indication for surgery included cancer and pelvic organ prolapse diagnoses based on International Classification of Disease (ICD) codes. Collected variables of interest included age, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) classification, uterine weight > 250 grams, and operative time. Our outcomes of interest included ELOS and readmission within thirty days. ELOS was defined as a hospital admission of two days or more after laparoscopic and transvaginal hysterectomy, and greater than three days for an abdominal hysterectomy. Summary statistics were used to evaluate shifts in patient characteristics and postoperative outcomes by hysterectomy route and year of surgery. Multivariable logistic regression analysis, stratified by year, comparing laparoscopic to transvaginal and abdominal hysterectomies, was performed.

MEASUREMENTS AND MAIN RESULTS: 224,357 patients that met the inclusion and exclusion criteria. Of those, 132,567 (59.1%) underwent a laparoscopic hysterectomy; 30,105 (13.4%) a vaginal hysterectomy; and 61,685 (27.5%) an abdominal hysterectomy. The rate of laparoscopic hysterectomy increased by more than 200% between 2007-2017, while the rates of transvaginal and abdominal hysterectomies steadily decreased (-58%, -42%, respectively]). The mean age, median obesity, and ASA classification increased amongst women undergoing hysterectomy across all routes with the sharpest increase within the laparoscopic hysterectomy group (% increase in mean age [2.1%, 1.3%, 0.7%] and mean BMI [9.1%, 4.3%, 3.7%] for laparoscopic, transvaginal and abdominal routes, respectively). In 2017 the odds of ELOS were 29% lower for those who received laparoscopic compared to those who received abdominal hysterectomy (P<0.001). Comparing the rates of readmission between the laparoscopic and abdominal hysterectomy groups shows that the odds of readmission is significantly lower for patients who receive a laparoscopic hysterectomy across all eleven years (P<0.001).

CONCLUSION(S): The rates of laparoscopic hysterectomy have been steadily increasing over the past eleven years. This large retrospective study confirms the lowest rates of readmission and extended length of stay within the laparoscopic hysterectomy group despite the rising medical complexity of the patients.

PMID:34610464 | DOI:10.1016/j.jmig.2021.09.714

J Psychiatr Res. 2021 Sep 24;144:102-109. doi: 10.1016/j.jpsychires.2021.09.050. Online ahead of print.

ABSTRACT

AIMS: Interventions to decrease readmissions in psychiatric patients are urgently needed. In Switzerland therapeutic leave (TL) composes a cornerstone of inpatient treatment. TL is a planned time-limited absence from the inpatient ward giving patients the opportunity to test their resilience in their usual environment. Evidence of its applicability as an intervention reducing readmissions is lacking. Therefore, our objective was to examine the association between TL and readmission risk.

METHODS: Using the Kaplan-Meier curve we compared the time to readmission of 3’302 inpatients at the UPK Basel with and without TL. Cox regression was applied, integrating other covariates associated with readmission.

RESULTS: The Kaplan-Meier curve indicated longer cumulative survival in patients with TL. The log-rank test implied statistical significance (χ²(1) = 18.8, p < .05). The Cox regression showed a reduced hazard for patients with TL (HR = 0.735, CI 95% = [0.639, 0.846], p < .001) and for involuntarily hospitalized patients (HR = 0.760, CI 95% = [0.618, 0.934], p < .01). A higher readmission risk was found for a history of psychiatric admissions (HR = 1.005, CI 95% = [1.004, 1.005], p < .001), higher severity of symptoms at admission (HR = 1.029, CI 95% = [1.018, 1.040], p < .001), comorbidity (HR = 1.178, CI 95% [1.024, 1.355], p = .022), and a diagnosis with schizophrenia-spectrum disorders (HR = 1.401, CI 95% [1.164, 1.687], p = .001).

CONCLUSION: Linking TL with readmission risk, our results imply an easy way to improve quality of care, with possible implications for practice, policies and quality interventions. TL might be suitable to enhance recovery, reduce readmissions and health care costs. RCTs are needed for validation.

PMID:34610513 | DOI:10.1016/j.jpsychires.2021.09.050

Infect Genet Evol. 2021 Oct 2:105091. doi: 10.1016/j.meegid.2021.105091. Online ahead of print.

ABSTRACT

BACKGROUND: Norovirus is a leading cause of viral gastroenteritis outbreaks worldwide. Histo-blood group antigens (HBGAs) are important host attachment factors in susceptibility to norovirus. In this study, the association of FUT2 gene, which participates in the biosynthesis of HBGAs, with norovirus infection has been investigated.

METHODS: All relevant studies on the associations of FUT2 gene with norovirus were retrieved from PubMed, Web of Science, Embase, and Cochrane Library databases. Odds ratios (ORs) and 95% confidence interval (CI) were used to analyze the extracted data. I² statistic, sensitivity analysis and publication bias analysis were used to confirm the findings. Subgroup analyses were performed for races, genotypes, development degree of the countries, publication years, age and setting when heterogeneity was recorded.

RESULTS: Twenty studies including 4066 participants were included for the meta-analysis. This analysis showed that there is a significant association between FUT2 gene and norovirus infection (OR = 3.02, 95%CI = 2.00-4.55, P < 0.001). Additionally, the ORs of norovirus infection among Chinese (OR = 4.49, 95%CI = 2.37-8.50, P < 0.001) were higher than those among Caucasian (OR = 3.23, 95%CI = 2.20-4.74, P < 0.001).

CONCLUSIONS: The meta-analysis suggested that FUT2 gene is associated with susceptibility to norovirus infection.

PMID:34610432 | DOI:10.1016/j.meegid.2021.105091

Neuroimage. 2021 Oct 2:118625. doi: 10.1016/j.neuroimage.2021.118625. Online ahead of print.

ABSTRACT

Graph models of the brain hold great promise as a framework to study functional and structural brain connectivity across scales and species. The network-based statistic (NBS) is a well-known tool for performing statistical inference on brain graphs, which controls the family-wise error rate in a mass univariate analysis by combining the cluster-based permutation technique and the graph-theoretical concept of connected components. As the NBS is based on group-level inference statistics, it does not inherently enable informed decisions at the level of individuals, which is, however, necessary for the realm of precision medicine. Here we introduce NBS-Predict, a new approach that combines the powerful features of machine learning (ML) and the NBS in a user-friendly GUI. By combining ML models with connected components in a cross-validation (CV) structure, the new methodology provides a fast and convenient tool to identify generalizable neuroimaging-based biomarkers. The purpose of this paper is to (i) introduce NBS-Predict and evaluate its performance using two sets of simulated data with known ground truths, (ii) demonstrate the application of NBS-Predict in a real case-control study, including resting-state functional magnetic resonance imaging (rs-fMRI) data acquired from patients with schizophrenia, (iii) evaluate NBS-Predict using rs-fMRI data from the Human Connectome Project 1200 subjects release. We found that: (i) NBS-Predict achieved good statistical power on two sets of simulated data; (ii) NBS-Predict classified schizophrenia with an accuracy of 90% using subjects’ functional connectivity matrices and identified a subnetwork with reduced connections in the group with schizophrenia, mainly comprising brain regions localized in frontotemporal, visual, and motor areas, as well as in the subcortex; (iii) NBS-Predict also predicted general intelligence scores from resting-state fMRI connectivity matrices with a prediction score of r = 0.2 and identified a large-scale subnetwork associated with general intelligence. Overall results showed that NBS-Predict performed comparable to or better than pre-existing feature selection algorithms (lasso, elastic net, top 5%, p-value thresholding) and connectome-based predictive modeling (CPM) in terms of identifying relevant features and prediction accuracy. Network-based statistic, machine learning, graph theory, biomarkers, functional connectivity, connectome-based prediction.

PMID:34610435 | DOI:10.1016/j.neuroimage.2021.118625

J Ethnopharmacol. 2021 Oct 2:114699. doi: 10.1016/j.jep.2021.114699. Online ahead of print.

ABSTRACT

ETHNOPHARMACOLOGICAL RELEVANCE: Danggui Buxue Decoction (DBT) is classical prescriptions, which contains two Traditional Chinese Medicines of Angelicae sinensis radix and Astragali radix. According to the preliminary work of our laboratory and numerous studies, it has been found that DBT has a therapeutic effect on diabetic nephropathy (DN). However, the mechanisms underlying its action remain unclear.

AIM OF THE STUDY: The aim of this study was to evaluate the impact of DBT on kidney disease in diabetic mice and further explore its protective mechanism.

METHODS: DN mice model was induced by high-fat fodder and streptozotocin (STZ). Qualitative and quantitative analysis of 6 compounds in DBT was carried out by HPLC, including calycosin-7-glucoside, ferulic acid, ononin, calycosin, formononetin, and levostilide A. Hematoxylin-Eosin (HE) staining was used to determine the degree of kidney pathological damage. The UPLC-Q Exactive MS technique was used to analyze the lipids metabolism profile of kidneys samples and multiple statistical analysis methods were used to screen and identify biomarkers. Transcriptomics analyses were carried out using RNAseq. The possible molecular mechanism was unraveled by network pharmacology.

RESULTS: Thirty-one significantly altered lipid metabolites were identified in the model group comparing with the control group. DBT improved aberrant expression of several pathways related to lipidomics, including glycerophospholipid metabolism and sphingolipid metabolism. Comprehensive analysis indicated that DBT intervention reduced the content of Cers, phosphatidylethanolamines and phosphatidylcholines in mouse kidneys by downregulating the transcription level of Degs2 and Cers, reducing lipid accumulation and promoting Akt phosphorylation by upregulating the expression of Acers and Pdk1. Network pharmacology analysis showed that components in DBT, such as kaempferol, ferulic acid and astragaloside IV, could be responsible for the pharmacological activity of DN by regulating the AGE-RAGE, PI3K/Akt, MAPK and NF-κB signaling pathways in diabetic complications.

CONCLUSIONS: These results showed that DBT may improve DN by affecting insulin resistance, chronic inflammation and lipid accumulation.

PMID:34610419 | DOI:10.1016/j.jep.2021.114699

J Vasc Interv Radiol. 2021 Oct 2:S1051-0443(21)01389-0. doi: 10.1016/j.jvir.2021.09.019. Online ahead of print.

ABSTRACT

PURPOSE: To assess the safety and efficacy of Genicular Artery Embolization (GAE) compared with a sham procedure in the treatment of knee pain secondary to mild-moderate grade Osteoarthritis (OA).

MATERIALS AND METHODS: A multicenter, single-blinded, randomized controlled trial was conducted to evaluate knee OA symptom reduction after GAE vs sham procedure. Subjects (n=21) with mild to moderate OA and intractable knee pain were randomized 2:1 to either GAE or a sham procedure. Subjects who were randomized to the sham procedure and did not report minimal clinical improvement in both total WOMAC and VAS scores were unblinded and able to crossover to treatment at 1 month. Longitudinal data were collected for 12 months, and subjects were excluded if they required additional analgesics at follow-up. Comparisons of reductions in VAS and Total WOMAC scores were performed using mixed effects linear regression models.

RESULTS: All subjects in the sham group failed to show significant improvements at 1 month and crossed over to the treatment arm.There was a statistically significant greater pain reduction in treatment group vs sham at 1 month (50.1mm VAS; SE=10.6, 95% CI: [29.0, 72.3], p<0.01). Disability improvement was also significantly greater in the treatment group (24.7 points WOMAC; SE=10.4, 95% CI: [3.5, 45.9], p=0.02). Only minor adverse events were reported.5 subjects were excluded after increased analgesic use. Sensitivity analysis with all excluded patients confirmed significant improvements at 1 and 12 months.

CONCLUSION: In patients with mild to moderate knee OA, GAE results in symptomatic improvement greater than sham procedure with clinically significant reduction in pain and disability.

PMID:34610422 | DOI:10.1016/j.jvir.2021.09.019