Tag: nevin manimala

J Am Heart Assoc. 2021 Oct 6:e020974. doi: 10.1161/JAHA.121.020974. Online ahead of print.

ABSTRACT

Background The Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score has been shown to predict out-of-hospital major bleeding after myocardial infarction treated with percutaneous coronary intervention and dual antiplatelet therapy (DAPT). However, large validation studies have been scarce and the discriminative ability for patients with a preexisting bleeding risk factor (elderly, underweight, women, anemia, kidney dysfunction, or cancer) in a real-world setting is unknown. Methods and Results Patients undergoing percutaneous coronary intervention for myocardial infarction between 2008 and 2017 were included from the SWEDEHEART (Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry (n=66 295). The predictive value of the PRECISE-DAPT score for rehospitalization with major bleeding during dual antiplatelet therapy was evaluated using receiver operating characteristic analyses. A high PRECISE-DAPT score (≥25; n=13 894) was associated with increased risk of major bleeding (3.9% versus 1.8%; hazard ratio [HR], 2.2; 95% CI, 2.0-2.5; P<0.001) compared with a non-high score (<25; n=52 401). The score demonstrated a c-statistic of 0.64 (95% CI, 0.63-0.66). The discriminative ability of the score to further stratify bleeding risk in patients with preexisting bleeding risk factors was poor, especially in patients who are elderly (c-statistic=0.57; 95% CI, 0.55-0.60) or underweight (c-statistic=0.56; 95% CI, 0.51-0.61), for whom a non-high PRECISE-DAPT score was associated with similar bleeding risk as a high PRECISE-DAPT score in the general myocardial infarction population. Conclusions In this nationwide population-based study, the PRECISE-DAPT score performed moderately in the general myocardial infarction population and poorly in patients with preexisting bleeding risk factors, where its usefulness seems limited.

PMID:34612051 | DOI:10.1161/JAHA.121.020974

Int J Lab Hematol. 2021 Oct 5. doi: 10.1111/ijlh.13727. Online ahead of print.

ABSTRACT

INTRODUCTION: An algorithmic approach, termed the prolonged clot time profile (PROCT), consisting of initial screening with prothrombin time (PT) and activated partial thromboplastin time (aPTT), reflexive mixing studies if indicated, and follow-up assays depending on initial testing results, offers an efficient approach to delineate the etiology of a prolonged PT/aPTT. Herein, we present the outcomes of the PROCT in the outpatient setting.

METHODS: In this retrospective study, we reviewed medical records of consecutive outpatients who had prolonged PT and/or aPTT noted in the routine coagulation laboratory and who had PROCT ordered in our institutional Special Coagulation Laboratory between 2010 and 2017.

RESULTS: One hundred and six patients, median age 55 years (IQR 30-67), met our study criteria. Twenty-nine patients had normal PT/aPTT, while 77 had persistent abnormalities and underwent reflexive testing. A prolonged PT, aPTT, or PT and aPTT was noted in 27 (35%), 27 (35%), and 23 (30%) respectively. Forty-nine (64%) had an acquired condition, 17 (22%) had a congenital condition, 7 (9%) had unclear etiology, and 4 (5%) were the result of laboratory artifact. The most common known cause of an isolated prolonged PT in our study was vitamin K deficiency in 8 (10%), the most common cause of an isolated prolonged aPTT was lupus anticoagulant in 4 (5%), and the most common cause of prolonged PT and aPTT was liver disease in 11 (14%).

CONCLUSION: Prolonged PT/aPTT have a wide range of causes, including artifactual prolongation or abnormalities in secondary hemostasis due to both inherited and acquired conditions.

PMID:34612006 | DOI:10.1111/ijlh.13727

Nat Commun. 2021 Oct 5;12(1):5820. doi: 10.1038/s41467-021-26013-4.

ABSTRACT

European governments use non-pharmaceutical interventions (NPIs) to control resurging waves of COVID-19. However, they only have outdated estimates for how effective individual NPIs were in the first wave. We estimate the effectiveness of 17 NPIs in Europe’s second wave from subnational case and death data by introducing a flexible hierarchical Bayesian transmission model and collecting the largest dataset of NPI implementation dates across Europe. Business closures, educational institution closures, and gathering bans reduced transmission, but reduced it less than they did in the first wave. This difference is likely due to organisational safety measures and individual protective behaviours-such as distancing-which made various areas of public life safer and thereby reduced the effect of closing them. Specifically, we find smaller effects for closing educational institutions, suggesting that stringent safety measures made schools safer compared to the first wave. Second-wave estimates outperform previous estimates at predicting transmission in Europe’s third wave.

PMID:34611158 | DOI:10.1038/s41467-021-26013-4

Nat Commun. 2021 Oct 5;12(1):5619. doi: 10.1038/s41467-021-25712-2.

ABSTRACT

Fast growing scientific topics have famously been key harbingers of the new frontiers of science, yet, large-scale analyses of their genesis and impact are rare. We investigated one possible factor connected with a topic’s extraordinary growth: scientific prizes. Our longitudinal analysis of nearly all recognized prizes worldwide and over 11,000 scientific topics from 19 disciplines indicates that topics associated with a scientific prize experience extraordinary growth in productivity, impact, and new entrants. Relative to matched non-prizewinning topics, prizewinning topics produce 40% more papers and 33% more citations, retain 55% more scientists, and gain 37 and 47% more new entrants and star scientists, respectively, in the first five-to-ten years after the prize. Funding do not account for a prizewinning topic’s growth. Rather, growth is positively related to the degree to which the prize is discipline-specific, conferred for recent research, or has prize money. These findings reveal new dynamics behind scientific innovation and investment.

PMID:34611161 | DOI:10.1038/s41467-021-25712-2

Qual Manag Health Care. 2021 Oct 4. doi: 10.1097/QMH.0000000000000338. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Length of stay is a common measure of efficiency of care. We aimed to reduce length of stay on a general medicine service through a structured quality improvement project.

METHODS: A reliable design strategy was implemented in successive stages at a 238-bed academically-affiliated VA hospital. Over a 2-year period, continuous improvement efforts were directed at discrete cohorts of patients deemed medically appropriate for discharge but who remained hospitalized because of discharge barriers. We compared the mean length of stay and medically-ready bed days of care for a hospital in statistical control charts. Pre- and post-intervention comparisons were made using t-tests.

RESULTS: In total, 5321 discharges were included in this improvement project, accounting for 35 852 bed days of care. Overall, average length of stay was reduced by 15.7%, from 7.62 to 6.40 days (P < .05). There was a significant reduction in the mean number of medically-ready bed days of care from 2.3 to 1.72. Statistical process control charts demonstrated special cause variation across patient cohorts.

CONCLUSION: A quality improvement project using reliable design principles was associated with shorter length of stay.

PMID:34611121 | DOI:10.1097/QMH.0000000000000338

Nat Commun. 2021 Oct 5;12(1):5840. doi: 10.1038/s41467-021-26027-y.

ABSTRACT

To gain insight into changes of scholarly journals’ recommendations, we conducted a systematic review of studies that analysed journals’ Instructions to Authors (ItAs). We summarised results of 153 studies, and meta-analysed how often ItAs addressed: 1) authorship, 2) conflicts of interest, 3) data sharing, 4) ethics approval, 5) funding disclosure, and 6) International Committee of Medical Journal Editors’ Uniform Requirements for Manuscripts. For each topic we found large between-study heterogeneity. Here, we show six factors that explained most of that heterogeneity: 1) time (addressing of topics generally increased over time), 2) country (large differences found between countries), 3) database indexation (large differences found between databases), 4) impact factor (topics were more often addressed in highest than in lowest impact factor journals), 5) discipline (topics were more often addressed in Health Sciences than in other disciplines), and 6) sub-discipline (topics were more often addressed in general than in sub-disciplinary journals).

PMID:34611157 | DOI:10.1038/s41467-021-26027-y

J Nurs Care Qual. 2021 Oct 4. doi: 10.1097/NCQ.0000000000000602. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 negatively impacts many organ systems including the skin. One of the most significant skin-associated adverse events related to hospitalization are pressure injuries.

PURPOSE: The aim of this study was to determine 8 risk factors that would place hospitalized patients at a higher risk for hospital-acquired pressure injuries (HAPIs) during the COVID-19 pandemic.

METHODS: A retrospective, descriptive analysis was conducted in an urban academic health science center located in the southeastern United States.

RESULTS: There were 247 of 23 093 patients who had pressure injuries and 1053 patients who had a positive COVID-19 diagnosis. Based on the generalized estimating equation model, diagnosis of COVID-19, age, male gender, risk of mortality, severity of illness, and length of stay are statistically significant factors associated with the development of HAPIs.

CONCLUSIONS: Further study should explore pathology of COVID-19 skin changes and what interventions are effective against HAPIs in the COVID-19 population taking into consideration current treatments.

PMID:34611108 | DOI:10.1097/NCQ.0000000000000602

J Craniofac Surg. 2021 Oct 5. doi: 10.1097/SCS.0000000000008267. Online ahead of print.

ABSTRACT

This study aimed to conduct a biomechanical investigation of the effects of systemic irisin hormone application on the osseointegration of titanium implants in rat tibias. After surgical implementation of titanium implants in the metaphyseal part of the tibiae of rats, the rats were randomly divided into 2 equal groups: control group (n = 10) and irisin group (n = 10). After surgery in the control group, the rats received no further treatment during the 4-week experimental period. The rats in the irisin group were given 100 ng/kg irisin every day for the 4-week experimental period after surgery. At the end of the experimental period, the rats were euthanized. Implants and surrounding bone tissues were collected for biomechanical (Newton) bone implant connection analysis. The Student t test was used for statistical analysis. There were no significant differences in the biomechanical osseointeration values (Newton) of the groups (P > 0.05, P = 0.59). Also, in the irisin group, there was numerically but not statistically more bone implant connection than in the controls. Within the limitations of this study, irisin did not affect the osseointegration of titanium implants.

PMID:34611101 | DOI:10.1097/SCS.0000000000008267

J Craniofac Surg. 2021 Oct 5. doi: 10.1097/SCS.0000000000008261. Online ahead of print.

ABSTRACT

PURPOSE: Inferior alveolar neurosensory disturbance (IAND) is the most common complication of bilateral sagittal split osteotomy (BSSO). The aim of the present study was to evaluate IAND with subjective tests postoperatively and assess the relationship between three-dimensional measurements of the mandibular canal (MC) and IAND.

METHODS: Eighteen patients (Mean age: 24.05 ± 5.85 years) treated with BSSO were retrieved from the archive. Subjective tests (light touch, tactile sensitivity, 2-point discrimination, brush-stroke directional discrimination, sharp/blunt discrimination, dental vitality, questionnaire) and three-dimensional measurements related to MC and fixation screws were done postoperatively (on average 20.43 ± 8.76 months after surgery). Statistical significance was set at P < 0.05.

RESULTS: Subjective test results were found compatible with each other except brush-stroke directional discrimination test. According to the questionnaire, IAND was apparent in all patients immediately after surgery, and recovery after 1 to 2 years was statistically significant (P < 0.05). Preoperative ramus width, medial and lateral cancellous bone lengths, the decrease in MC length, and the presence of screw in MC were not related to IAND (P < 0.05).

CONCLUSIONS: There is a high incidence of IAND following BSSO, and the subjective tests are efficient to evaluate the disturbance. Spontaneous recovery of the nerve occurs during the follow-up periods. Instead of preoperative measurements of bone thickness, MC length, and the position of fixation screws, the surgical procedure seems to be more important in IAND occurrence.

PMID:34611107 | DOI:10.1097/SCS.0000000000008261

Ann Plast Surg. 2021 Oct 4. doi: 10.1097/SAP.0000000000003027. Online ahead of print.

ABSTRACT

A number of studies have already examined gluteal reconstruction with free flaps. Thus, the aim of this study was to investigate the reliability of free flap reconstruction for oncologic gluteal defects. This retrospective cohort study included 23 patients who underwent immediate soft tissue reconstruction for an oncologic gluteal defect. Fifteen patients underwent reconstruction with a free flap and 8 with a regional flap. The postoperative results were compared between the free and regional flaps. In the free flap group, the latissimus dorsi musculocutaneous flap was used in 12 patients, the thoracodorsal artery perforator flap in 2 patients, and the anterolateral thigh flap in 1 patient. Recipient vessels were the inferior gluteal vessels or their branches in 8 patients and the superior gluteal vessels or their branches in 7 patients. All flaps have fully survived in both groups without vascular compromise. Dehiscence of the gluteal wound tended to be more common in the regional flap group; however, the difference between the groups was not statistically significant. The use of free flap reconstruction for large oncologic defects in the gluteal region is a feasible and reliable option. Tension-free wound closure and simplified suture lines can provide reliable wound coverage irrespective of the postoperative patient’s position or movement. Because of the risk of postoperative compression on the vascular pedicle, selecting the appropriate recipient vessel and type of microvascular anastomosis is key for the success of free flap transfer in this region.

PMID:34611088 | DOI:10.1097/SAP.0000000000003027