Tag: nevin manimala

Am J Emerg Med. 2021 Aug 16;50:264-269. doi: 10.1016/j.ajem.2021.08.035. Online ahead of print.

ABSTRACT

BACKGROUND: Unintentional injury remains the leading cause of death for adults worldwide. We aimed to investigate the rates and distribution of dead on arrival (DOA) patients according to emergency medical services (EMS) mode of transport (MoT), EMS transport time (TT), injury severity score (ISS), and type of injury.

METHODS: This retrospective study utilized de-identified incident-based data from the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP PUF) dataset (2013-2018) to study Adult DOA patients. DOA was defined according to the data point, “arrived with no signs of life and did not recover”. Patients with unknown vitals and patients with no EMS vitals at the scene (HR = 0, RR = 0, and SBP = 0) were excluded to identify DOAs who died during transport. The DOAs included for analysis were sorted into three groups based on injury severity score [low (ISS < 15), intermediate (ISS = 15-24), and severe (ISS ≥ 25)] and subdivided according to injury type (blunt vs. penetrating), EMS Mode of transport and transport times. Statistical significance was defined as p < 0.05.

RESULTS: The majority of the evaluated 6030 adult DOA patients were male (73.3%) and 18-64 years of age (79.6%). Most patients sustained blunt injuries (58.2%), and the most common mechanism of injury was motor vehicle collisions (MVCs). Patients who traveled by helicopter EMS (HEMS) experienced less deaths than those traveling by ground EMS (GEMS) despite transporting more severely injured patients over longer time intervals. Median HEMS TTs were greater than their GEMS counterparts for blunt and penetrating injuries across all ISS groups but were associated with fewer deaths.

CONCLUSION: Helicopter emergency medical service use with intermediate and severely injured patients with penetrating injuries is associated with a reduced number of DOAs. Future studies should prospectively investigate EMS performance to confirm the findings identified in this retrospective analysis. Additionally, other factors affecting pre-hospital EMS performance (e.g., geographic variations, weather-related characteristics, in-flight interventions/procedures) should be investigated. Finally, the results of this study highlight the need for standardized HEMS utilization triage criteria.

PMID:34418717 | DOI:10.1016/j.ajem.2021.08.035

Am J Emerg Med. 2021 Aug 10;50:278-282. doi: 10.1016/j.ajem.2021.07.063. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to investigate the effect of compression on the Visual Analog Scale (VAS) score following the application of 3-in-1 femoral nerve block (FNB), used for pain palliation in patients with hip fractures.

METHODS: This was a randomized controlled trial study on application of pressure versus no pressure following FNB in patients with hip fractures. Their VAS scores were recorded and an ultrasound-guided 3-in-1 FNB was performed as a standardized procedure. After the procedure, patients were randomized into two groups and a weight with 2 kg pressure was applied to the treated area in one group. After 30 min, VAS scores were recorded again. VAS scores of all patients recorded before and after the procedure, and post-procedural VAS scores of pressure-applied and no pressure-applied groups were statistically compared.

RESULTS: 34 patients were included in this study with 17 patients falling in the compression group (group C), and the remaining half in the non-compression group (group NC). The pre-procedural mean VAS scores were 9.35 (95% CI; 8.95-9.76)), while the post-procedural mean VAS scores dropped to 2.35 (95% CI; 1.65-3.06) in group C. The pre-procedural mean VAS score was 9.12 (95% CI; 8.64-9.59), while the post-procedural mean VAS score was 5.06 (95% CI; 4.09-6.03) in group NC. When the average reductions in VAS score following the procedure were compared, the mean difference between the two groups was calculated to be 2.94 (95% CI; 1.69-4.19) which favours group C. This difference was statistically significant (p < 0.001).

CONCLUSION: Our study shows that, the application of simple compression after 3-in-1 FNB in patients with hip fractures provides a significant reduction in VAS scores.

PMID:34418719 | DOI:10.1016/j.ajem.2021.07.063

J Stroke Cerebrovasc Dis. 2021 Aug 18;30(10):106050. doi: 10.1016/j.jstrokecerebrovasdis.2021.106050. Online ahead of print.

ABSTRACT

INTRODUCTION: Exercise therapy and neuromuscular electrical stimulation (NMES) during the initial 14 days after stroke may benefit recovery of gait. We aimed to determine whether poststroke NMES of vastus medial and tibial muscles during exercise therapy is more effective than exercise therapy alone.

MATERIALS AND METHODS: In this proof-of-concept randomised trial patients with first-ever acute ischemic stroke and a leg paresis (40-85 years of age) were randomised (1:1) to 10 min of daily NMES + exercise therapy or exercise therapy alone. Primary outcome was the between-group difference in change in 6 min Walk Test (6MWT) at 90 days post stroke estimated with a mixed regression model. Secondary outcomes included 10 m Walk Test, Fugl-Meyer Motor Assessment, Guralnik Timed Standing Balance, Sit to Stand, Timed Up and Go, EQ-5D-5L, Montreal Cognitive Assessment and Becks Depression Inventory.

RESULTS: 50 stroke survivors (25 in each group) with a mean age of 67 years (range 43-83) were included. An insignificant between-group difference in change of 28.3 m (95%CI -16.0 to 72.6, p = 0.23, adjusted for baseline) in 6MWT at 90-days follow-up was found, in favour of the NMES group. All secondary outcomes showed no statistically significant between-group difference. The conclusion was that adding NMES to exercise therapy had no effect on poststroke walking distance measured by the 6 MWT or any of the secondary outcomes.

CONCLUSIONS: In this proof-of-concept RCT, we demonstrated that NMES in addition to exercise therapy during the first 14 days after onset of ischemic stroke did not improve walking distance or any of the secondary outcomes. Future studies with a longer trial period, stratifying patients into subgroups with comparable patterns of expected spontaneous recovery – if possible within 48 h post stroke, and greater sample size, than in this study are suggestions of how rehabilitation research could go on exploring the potential for NMES as an amplifier in stroke recovery.

PMID:34418670 | DOI:10.1016/j.jstrokecerebrovasdis.2021.106050

Eur J Obstet Gynecol Reprod Biol. 2021 Aug 11;265:30-38. doi: 10.1016/j.ejogrb.2021.07.038. Online ahead of print.

ABSTRACT

OBJECTIVE: Following the publication of several high quality randomized controlled trials regarding the comparison of similar laparoscopic gynecologic procedures being performed with or without robotic assistance, we aimed to perform a systematic review to identify any differences in patient safety and expected incidence of complications in these procedures.

DATA SOURCES: Articles on ClinicalTrials.Gov, Embase, MEDLINE, PubMed, Scopus, and Web of Science databases were retrieved and screened for eligibility up to April 1st 2021.

METHODS OF STUDY SELECTION: In addition to meeting our screening algorithm, we included studies that met all the following: randomized control trials (RCT), enrolling patients for indicated laparoscopic gynecologic procedures, and comparing Robotic Surgery (RS) with Laparoscopic Surgery (LS) in terms of safety or complications.

TABULATION, INTEGRATION, AND RESULTS: Data was pooled as mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI). Ultimately, six studies were included in this meta-analysis. Pooled data revealed that RS and LS have similar risk for intraoperative complications (RR = 0.87; 95% CI [0.23, 3.36], P = 0.84), postoperative complications (RR = 1.07; 95% CI [0.57, 2.01], P = 0.83), significant intraoperative hemorrhage (RR = 1.40; 95% CI [0.59, 3.34], P = 0.44), postoperative hemorrhage (RR = 0.43; 95% CI [0.15, 1.22], P = 0.11), vaginal cuff dehiscence (RR = 1.13; 95% CI [0.24, 5.41], P = 0.88), postoperative wound infection, urinary tract infection, and urinary bladder or ureteral injury. RS had “surgeon declared” lower estimated blood loss (MD = 85.27; 95% CI [46.45, 124.09], P < 0.00001) and shorter postoperative hospital stay (MD = 1.20; 95% CI [0.38, 2.01], P = 0.004).

CONCLUSION: There was a statistically significant decrease in hospital stay and “surgeon declared” blood loss seen in the RS group. There was no statistically significant increase in risk of developing other postoperative complications between the LS and R groups.

PMID:34418694 | DOI:10.1016/j.ejogrb.2021.07.038

Epilepsy Behav. 2021 Aug 18;123:108247. doi: 10.1016/j.yebeh.2021.108247. Online ahead of print.

ABSTRACT

OBJECTIVE: The effect of vagus nerve stimulation (VNS), an important auxiliary therapy for treating drug-resistant epilepsy (DRE), on autonomic nerve function is still controversial. Heart rate variability is a widely used indicator of autonomic nerve function. To clarify the relationship between VNS and heart rate variability (HRV), we performed a meta-analysis to systematically evaluate the effect of VNS on HRV in patients with epilepsy.

METHODS: We performed a systematic review by searching the following online databases: PubMed, Web of Science, EMBASE and the Cochrane Library. The key search terms were “vagal nerve stimulation,” “epilepsy” and “heart rate variability”. Other features of VNS in patients with epilepsy include postoperative changes in low-frequency (LF), high-frequency (HF) and low-frequency/high-frequency (LF/HF) heart rate variability, which were used as evaluation indices, and the Newcastle-Ottawa Quality Assessment Scale and Stata 14.0 statistical software were used for literature quality evaluation and meta-analysis.

RESULTS: Twelve studies published in English were obtained, and 229 patients with epilepsy who underwent VNS were ultimately included after elimination of duplicate articles and those that did not meet the inclusion criteria. Regarding LF heart rate variability, in the response subgroup, patients with DRE with VNS presented a lower value (-0.58) before surgery than after surgery, with a 95% confidence interval (CI) ranging from -1.00 to -0.15. For HF heart rate variability, patients with DRE with VNS had a lower value (-0.45) before surgery than after surgery in the response subgroup, with a 95% CI ranging from -0.74 to -0.17. No differences were found for LF/HF values or the LF and HF values of other subgroups.

CONCLUSION: VNS has little effect on the balance of sympathetic and parasympathetic nerve activity and would not be expected to cause cardiovascular autonomic dysfunction in patients with DRE. For patients with DRE, VNS can control seizures and has little effect on autonomic nervous function.

PMID:34418640 | DOI:10.1016/j.yebeh.2021.108247

Cancer Epidemiol. 2021 Aug 18;74:102006. doi: 10.1016/j.canep.2021.102006. Online ahead of print.

ABSTRACT

INTRODUCTION: Childhood brain tumours (CBTs) are the second most common type of cancer in individuals aged 0-24 years globally and cause significant morbidity and mortality. CBT aetiology remains poorly understood, however previous studies found higher CBT incidence in high-income countries (HIC) compared to low-middle income countries (LMIC), suggesting a positive relationship between incidence and wealth.

MATERIALS & METHODS: Aggregated data from Cancer Incidence in Five Continents (CI5) were used to explore CBT epidemiology. Incidence rate ratios (IRR) compared CBT rates between twenty-five geographically and economically diverse countries. The relationship between incidence and economic development was explored using linear regression models and Spearman’s rank correlation tests. Trends in CBT incidence between 1978 and 2012 were investigated using average annual percentage changes (AAPC).

RESULTS: CBT incidence was highest in North America and lowest in Africa. CBT incidence rates increased significantly with increasing GDP per capita (p = 0.006). Gini index was significantly negatively associated with CBT incidence. Incidence decreased with increasing income inequality within countries, indicated by higher Gini indices (p = 0.040). Increasing and decreasing CBT incidence trends were observed within individual countries, although only Italy (p = 0.02) and New Zealand (p < 0.005) experienced statistically significant changes over time.

CONCLUSIONS: The excess disease found in HIC may be explained by environmental risk factor exposure increasing CBT risk in wealthy populations. However, systematic limitations of substandard cancer detection and reporting in LMIC may mean incidence disparities result from misinformation bias rather than genuine differences in risk factor exposure. Further research is required to comprehensively describe CBT epidemiology and explain study findings.

PMID:34418666 | DOI:10.1016/j.canep.2021.102006

Am J Obstet Gynecol MFM. 2021 Aug 18:100466. doi: 10.1016/j.ajogmf.2021.100466. Online ahead of print.

ABSTRACT

BACKGROUND: Maternal biologic factors can affect fetal fraction in cell-free DNA-based prenatal screening assays, thereby limiting effectiveness. Higher rates of indeterminate results from low fetal fraction have been described in cases of autoimmune disease in pregnancy. Existing studies are confounded by the concomitant maternal use of anticoagulants, which may independently influence test characteristics.

OBJECTIVE(S): To evaluate differences in fetal fraction, indeterminate results, and total cell-free DNA concentration for women with autoimmune disease compared to controls using our in-house developed non-invasive prenatal screening platform in the absence of maternal anticoagulation use.

STUDY DESIGN: A retrospective, single institution cohort study of a previously validated cell-free DNA-based non-invasive prenatal screening assay using a low-pass whole genome sequencing platform between 2017 and 2019. A diagnosis of autoimmune disease included systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease, and others. Immunomodulator therapies included biologics, corticosteroids, hydroxychloroquine, azathioprine, and intravenous immunoglobulin. Women on anticoagulation were excluded. We evaluated the association between autoimmune disease and fetal fraction, indeterminate results, and total cell-free DNA concentration using univariate and multivariate analyses, stratifying for immunomodulator therapy and adjusting for body mass index, fetal sex, and gestational age at sample collection.

RESULTS: 1,445 patients met inclusion criteria. Forty-three women had a confirmed autoimmune disease, with 25 not on immunomodulator therapy and 18 on immunomodulator therapy. The mean fetal fraction for women with autoimmune disease was significantly lower compared to controls (9.7% vs. 11.9%, p=0.004). The rate of indeterminate results was significantly higher for women with autoimmune disease compared to controls (16.3% vs. 3.5%; p<0.001). The total cell-free DNA concentration was not statistically different between groups (94.8 pg/uL for autoimmune disease vs. 83.9 pg/uL for controls, p=0.06). In logistic regression, women with autoimmune disease had a significantly higher odds of an indeterminate result compared to controls, (aOR 5.3, 95%CI 2.0, 14.2). Linear regression showed a significant negative association between autoimmune disease and fetal fraction (aβ -2.1, 95%CI -3.4, -0.6). Stratifying by treatment status, mean fetal fraction was 9.8%, 9.6%, and 11.9% for women with autoimmune disease not on immunomodulator therapy, autoimmune disease on immunomodulator therapy, and controls, respectively (p=0.02). The rate of indeterminate results increased in a stepwise fashion from 3.5% to 11.1% to 20.0% for controls, autoimmune disease on immunomodulator therapy, and autoimmune disease not on immunomodulator therapy, respectively (p<0.001). Logistic regression demonstrated higher odds of an indeterminate result for women with autoimmune disease not on immunomodulator therapy compared to controls, (aOR 7.3, 95%CI 2.3, 22.5). Autoimmune disease not on immunomodulator therapy was negatively associated with fetal fraction compared to controls (aβ -2.2, 95%CI -4.2, -0.3).

CONCLUSION(S): Women with autoimmune disease have lower fetal fraction and higher rates of indeterminate results compared to women without autoimmune disease. There was no difference in total cell-free DNA concentration. Treatment of maternal autoimmune disease with immunomodulator therapy may decrease the indeterminate result rate.

PMID:34418590 | DOI:10.1016/j.ajogmf.2021.100466

Epilepsy Behav. 2021 Aug 18;123:108259. doi: 10.1016/j.yebeh.2021.108259. Online ahead of print.

ABSTRACT

OBJECTIVE: Depression and anxiety disorders are common among patients with epilepsy (PWE). These comorbidities have been shown to influence prognosis and may have a greater impact on quality of life than seizure control. Despite guideline recommendations and expert consensus to regularly screen for and treat both conditions, there is evidence that they are underdiagnosed and undertreated. Our goal was to test a novel screening method to determine if it would increase the rate of detecting and treating depression and anxiety disorders among PWE.

METHOD: The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the Brief Epilepsy Anxiety Survey Instrument (brEASI) were selected as validated screening instruments for depression and anxiety disorders, respectively. They were sent via an electronic medical record-linked patient portal to all patients of four epileptologists 48 h prior to their clinic appointment. We evaluated whether this increased the rate of detecting and treating depression and anxiety disorders relative to a historical control group.

RESULTS: A total of 563 patients were included of whom 351 were sent the screening instruments. 62.7% of patients completed the screening instruments of whom 47.7% screened positive for either depression only (16.4%), anxiety disorders only (5.5%) or both (25.9%); a statistically significant increase relative to the control group. There was also a significantly increased proportion of patients for whom treatment was initiated for depression (p < 0.01), anxiety disorders (p < 0.01), or both (p < 0.01).

CONCLUSIONS: We identified an easily applicable and efficient means of enhancing detection and treatment rates for depression and anxiety disorders among PWE in a busy clinic setting.

PMID:34418639 | DOI:10.1016/j.yebeh.2021.108259

Pharmacol Res. 2021 Aug 18:105836. doi: 10.1016/j.phrs.2021.105836. Online ahead of print.

ABSTRACT

Despite Sodium-glucose co-transporter-2 (SGLT2) inhibitors have been associated with a reduced risk of heart failure in patients with type 2 diabetes mellitus (T2DM), the effect observed for other cardiovascular (CV) and cerebrovascular outcomes differed among clinical trials. Different observational studies have investigated the effects of SGLT2 inhibitors on these outcomes and mortality. The present meta-analysis aimed to assess the effects of SGLT2 inhibitors on the risk of CV (major adverse CV event – MACE, non-fatal myocardial infarction, or hospitalization for heart failure) and cerebrovascular (stroke) outcomes. A systematic review was conducted in Pubmed from January 1, 2012 to November 31, 2020. Only retrospective cohort studies including as control group users of dipeptidyl peptidase-4 (DPP-4) inhibitors or non-SGLT2 inhibitors were retained and analysed separately. A random effect meta-analysis approach was used. This study followed the PRISMA statement. Of the 158 references identified, 20 articles were selected for meta-analysis, of which 13 considered the comparison with DPP-4 inhibitors and 7 the comparison with non-SGLT2 inhibitors. The pooled intention-to-treat analysis showed a reduced risk of stroke with SGLT2 inhibitors compared to DPP-4 inhibitors (Hazard ratio HR, 0.89; 95%CI, 0.82-0.96; I² = 25%; p = 0.25) and non-SGLT2 inhibitors (HR, 0.83; 95%CI, 0.77-0.91; I2 = 11%; p = 0.34). Finally, SGLT2 inhibitors were also associated with a reduced risk of CV outcomes and mortality in all comparisons. Our data support contemporary society recommendations to prioritize the use of SGLT2 inhibitors in patients with T2DM and at high risk for CV complications.

PMID:34418562 | DOI:10.1016/j.phrs.2021.105836

Nurse Educ Today. 2021 Aug 8;106:105081. doi: 10.1016/j.nedt.2021.105081. Online ahead of print.

ABSTRACT

BACKGROUND: Traditional teaching approaches are generally teacher-directed, and students are taught in a manner that is conducive to sitting and listening. Using three-dimensional (3D) holograms has many benefits in a higher education environment. However, relevant studies on this topic are very limited.

OBJECTIVES: To confirm the efficacy of 3D holograms for educational purposes to support the academic and practical performance of nursing students.

DESIGN: A randomly allocated pretest and posttest quasi-experimental design.

SETTINGS: Mackay Medical College in Taiwan.

PARTICIPANTS: Ninety third-year nursing students at a medical school in Taiwan.

METHODS: The data were collected between January and May 2020. The participants were randomly allocated to an intervention group and a control group. The learning method used in the intervention group was a combination of a 3D hologram learning module and classroom lectures. The control group was exposed to classroom lectures without 3D holograms. The tool included hardware (Windows Mixed Reality Helmet and VR Remote Control) and software (Health Assessment® and Patient First Patient Condition VR System®). The Health Assessment and Practice Knowledge Assessment tool and the Health Assessment and Practice Techniques Performance tool were used to evaluate the effects of the study intervention on the knowledge and techniques of the students.

RESULTS: A total of 79 participants (40 in the intervention group and 39 in the control group) were included in the final statistical analysis. The response rate was 88%. Statistically significant differences in knowledge and practical learning in the health assessment and practice course were observed between the intervention group and the control group (p < .05). The η² effect level was 0.134.

CONCLUSIONS: After attending classroom lectures, the students who also attended the 3D hologram-based laboratory courses had significantly higher knowledge and practical learning scores. This approach may be used as a complementary learning tool in higher education.

PMID:34418588 | DOI:10.1016/j.nedt.2021.105081