Tag: nevin manimala

Invest Educ Enferm. 2021 Jun;39(2). doi: 10.17533/udea.iee.v39n2e07.

ABSTRACT

OBJECTIVES: This research sets out the effects of a training method based on peer tutoring, aimed at developing empathy among nursing students at the University of Barcelona (Spain).

METHODS: After initial training, students are matched in pairs with similar level of empathy, exchanging the role of tutor and tutee in every session, during 12 sessions. Before the session, the tutor prepares the activities to work with his or her tutee, following this structure: exploration of prior knowledge, explanation, practical activities, feedback, and reflection. Jefferson Scale of Empathy was administered as pre-test and post-test to 76 nursing students, 40 in the intervention group, and 36 in the comparison group. Following a mixed-methods sequential explanatory design, a quantitative study (a quasi-experimental design with a comparison group) was combined with a qualitative study (interaction analysis of the 12 videotaped sessions).

RESULTS: The results revealed statistically significant improvements in empathy in the intervention group. Subsequent analysis of the peer tutoring interaction highlighted the specific actions that had resulted in these improvements and generated a context in which the tutee was able to understand complex concepts, while enabling both students to participate, reflect and discuss.

CONCLUSIONS: Peer tutoring is an effective method for the development of empathy in nursing students.

PMID:34214284 | DOI:10.17533/udea.iee.v39n2e07

Invest Educ Enferm. 2021 Jun;39(2). doi: 10.17533/udea.iee.v39n2e11.

ABSTRACT

OBJECTIVES: To evaluate the effects of application of a manual on the improvement of alarms management in Intensive Care Units (ICU).

METHODS: This quasi-experimental study evaluated the effectiveness of the introduction into of a manual for alarm management and control in the ICU of a hospital in southeastern Iran. The intervention was a 4-hour workshop was on topics related to the adverse effects of alarms, standardization of ECG, oxygen saturation and blood pressure monitoring systems, and the use of ventilators and infusion pumps. Data were collected thorough 200 hours of observation of 60 ICU nurses (100 hours’ pre-intervention and 100 hours’ post-intervention). Response time, type of response, customization of alarm settings for each patient, the person responding to an alarm, and the cause of the alarm were analyzed. Alarms were classified into three types: false, true and technical.

RESULTS: The results showed a statistically significant difference between the pre- and post-intervention frequency of alarm types, frequency of monitoring parameters, customized monitoring settings for patients, and individuals who responded to alarms. The percentage of effective interventions was significantly higher for all parameters after the intervention (46.9%) than before the intervention (38.9%).

CONCLUSIONS: The employment of a manual for management of alarms from electronic equipment in ICUs can increase the frequency of appropriate responses to alarms in these units.

PMID:34214288 | DOI:10.17533/udea.iee.v39n2e11

Bipolar Disord. 2021 Jul 2. doi: 10.1111/bdi.13109. Online ahead of print.

ABSTRACT

We read the article by Ahmad et al¹ with great interest. The study concluded that endoxifen is efficacious and safe in patients with acute manic episodes with/without mixed features. However, we are worried about internal and external validity of study results. We have reservations about the sample size estimation, statistical analysis, and missing data handling. Sample size, in a randomized clinical trial depends on the study hypothesis, i.e., superiority, non-inferiority or equivalence of two treatments. The efficacy endpoints briefly mentioned “endoxifen was considered non-inferior to divalproex if the lower limit of 95% CI was greater than -10,”-suggested a possibility of non-inferiority design. However, the “non-inferiority margin” was not based on statistical considerations.² Moreover, we did not find any mention of non-inferiority between endoxifen and divalproex in the article, except for a passing remark. Further, in a multicentric study, between-centre heterogeneity needs to be accounted for in the sample size calculation and in analysis.³ Extremely unequal centre enrolment and apparent heterogeneity in practice (use of rescue medication only in one centre) added to this concern further.

PMID:34214241 | DOI:10.1111/bdi.13109

Transbound Emerg Dis. 2021 Jul 2. doi: 10.1111/tbed.14214. Online ahead of print.

ABSTRACT

In Brazil, notification of toxoplasmosis outbreaks and epidemiological investigation is a mandatory activity of health surveillance. We investigated the risk factors for toxoplasmosis during outbreaks, notifications of outbreaks by the Health Secretary, and reports in the literature. Other factors related to the municipalities were determined through the Institute of Geography and Statistics portal. We found that fruits and vegetables were the most described transmission routes in outbreaks, and oocysts were the most common parasitic form; in recent years, there has been an increase in outbreak notifications. We also found that municipalities with high IDHM have higher numbers of toxoplasmosis infections during outbreaks. There is a need to raise awareness among the population and producers regarding good water management and quality practices and to facilitate the acquisition of complex data to improve preventive strategies. This article is protected by copyright. All rights reserved.

PMID:34214245 | DOI:10.1111/tbed.14214

Invest Educ Enferm. 2021 Jun;39(2). doi: 10.17533/udea.iee.v39n2e05.

ABSTRACT

OBJECTIVES: To estimate the combined effect of educational interventions (EI) on decreased readmissions and time of hospital stay in adults with heart failure, compared with usual care.

METHODS: Systematic review (SR) and meta-analysis (MA) of randomized controlled trials that followed the recommendations of the PRISMA statement. The protocol was registered on PROSPERO (CRD42019139321). Searches were made from inception until July 2019 in the databases of PubMed/Medline, Embase, Cochrane CENTRAL, Lilacs, Web of Science, and Scopus. The MA was conducted through the random effects model. The effect measure used for the dichotomous outcomes was relative risk (RR) and for continuous outcomes the mean difference (MD) was used, with 95% confidence intervals (CI). Heterogeneity was evaluated through the inconsistency statistic (I2).

RESULTS: Of 2369 studies identified, 45 were included in the SR and 43 in the MA. The MA of studies with follow-up at six months showed a decrease in readmissions of 30% (RR: 0.70; 95% CI: 0.58 to 0.84; I2: 0%) and the 12-month follow-up evidenced a reduction of 33% (RR: 0.67; 95% CI: 0.58 to 0.76; I2: 52%); both analyses in favor of the EI group. Regarding the time of hospital stay, a reduction was found of approximately two days in patients who received the EI (MD: -1.98; 95% CI: -3.27 to -0.69; I2: 7%).

CONCLUSIONS: The findings support the benefits of EI to reduce readmissions and days of hospital stay in adult patients with heart failure.

PMID:34214282 | DOI:10.17533/udea.iee.v39n2e05

J Clin Pharmacol. 2021 Jul 2. doi: 10.1002/jcph.1934. Online ahead of print.

ABSTRACT

Perhexiline has been used to treat hypertrophic cardiomyopathy. In addition to its effect on carnitine-palmitoyltransferase-1, it has mixed ion channel effects through inhibition of several cardiac ion currents. Effects on cardiac ion channels expressed in mammalian cells were assayed using manual patch-clamp technique, action potential duration (APD) were measured in ventricular trabeculae of human donor hearts, and ECG effects were evaluated in healthy subjects in a thorough QT (TQT) study. Perhexiline blocked several cardiac ion currents at concentrations within the therapeutic range (150 – 600 ng/mL) with IC₅₀ for hCav1.2 ∼ hERG < late hNav1.5. A significant APD shortening was observed in perhexiline treated cardiomyocytes. The TQT study was conducted with a pilot part in 9 subjects to evaluate a dosing schedule that would achieve therapeutic and supratherapeutic perhexiline plasma concentrations on Day 4 and 6, respectively. Guided by the results from the pilot, 104 subjects were enrolled in a parallel designed part with a nested cross-over comparison for the positive control. Perhexiline caused QTc prolongation, with a largest effect on ΔΔQTcF of 14.7 msec at therapeutic and 25.6 msec at supratherapeutic concentrations and a positive and statistically significant slope of the concentration-ΔΔQTcF relationship: 0.018 msec per ng/mL; 90% CI: 0.0119 to 0.0237. In contrast, the JTpeak interval was shortened with a negative concentration-JTpeak relationship, a pattern consistent with multichannel block. Further studies are needed to evaluate whether this results in a low proarrhythmic risk.

PMID:34214210 | DOI:10.1002/jcph.1934

J Cosmet Dermatol. 2021 Jul 2. doi: 10.1111/jocd.14331. Online ahead of print.

ABSTRACT

BACKGROUND: Aesthetic improvement of the neck and cervicomental angle remains one of the most challenging aspects of rejuvenation. Fractional radiofrequency microneedling demonstrated significant skin tightening and lifting of lower third of the face.

AIM OF WORK: To evaluate and compare fractional radiofrequency microneedling alone and in combination with autologous platelet rich plasma (PRP) in neck rejuvenation.

METHODS: 20 patients with mild to moderate neck laxity were randomized to receive 3 sessions of either fractional radiofrequency microneedling + PRP (group A) or fractional radiofrequency microneedling monotherapy (group B). Evaluation was done using optical coherence tomographgy to detect dermis thickness, measurement of cervicomental angle, a score done by two investigators blinded to used modality (GAIS) and patient satisfaction score.

RESULTS: Both Groups showed a statistically significant improvement in all parameters. Comparing the two groups the mean dermal thickness after treatment was higher in group A compared to B but was found statistically insignificant. More favorable results were reported in group A according to GAIS. Other parameters showed comparable results.

CONCLUSION: Fractional micro-needle radiofrequency with insulated microneedles offers a safe and effective modality for mild to moderate neck laxity when used alone or in combination with PRP. It remains questionable whether combining fr-RF microneedling with PRP provides more favorable results in terms of efficacy and side effects.

PMID:34214220 | DOI:10.1111/jocd.14331

Neuromodulation. 2021 Jul 2. doi: 10.1111/ner.13490. Online ahead of print.

ABSTRACT

OBJECTIVES: Hypoglossal nerve stimulation is an effective treatment option for obstructive sleep apnea (OSA) in positive airway pressure therapy failure. Nonetheless, data regarding the functional effect of modifying stimulation parameters within each electrode configuration are limited.

MATERIALS AND METHODS: In a retrospective study of 76 patients with 12 months or more follow-up, functional tongue protrusion thresholds were compared for pulse width and frequency configurations of 90 μsec 33 Hz vs 120 μsec 40 Hz. The number of tolerated voltage amplitude steps between sensation, functional, and subdiscomfort thresholds were assessed for both settings as well as impedances.

RESULTS: The overall cohort showed improvement in OSA metrics: median apnea-hypopnea index from 30.0/hour to 18.6/hour and Epworth Sleepiness Scale from 13.5 to 7.6. For both bipolar and unipolar electrode configurations, the stimulation amplitude required for functional tongue protrusion was significantly reduced when the pulse width and frequency were converted from 90 μsec 33 Hz to 120 μsec 40 Hz (p < 0.001). Nevertheless, the number of voltage amplitude steps from sensation, functional, to subdiscomfort thresholds did not differ between the two settings. The ratio of automatically derived impedances between bipolar and unipolar electrode configurations was relevantly correlated with the ratio of functional thresholds at these parameters.

CONCLUSION: Changing the stimulation parameters may lower the voltage requirements while maintaining the same effect on tongue protrusion. Changing these stimulation parameters does not affect the range of tolerated impulse steps between functional and subdiscomfort thresholds. Future technical appliances could help estimate functional thresholds at different electrode configurations for each patient by automatically measuring impedances.

PMID:34214238 | DOI:10.1111/ner.13490

Int J Geriatr Psychiatry. 2021 Jul 2. doi: 10.1002/gps.5595. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to examine whether loneliness mediates these associations among middle-aged and older adults.

METHODS: Data from wave 10 (2010-2012) to wave 13 (2016-2017) of the Health and Retirement Study (HRS) were analyzed. Perceived neighborhood characteristics were self-reported. Loneliness was measured by Revised University of California Los Angeles (R-UCLA) Loneliness Scale. Cognition was evaluated by the modified version of Telephone Interview for Cognitive Status (TICS). Baron and Kenny’s causal steps and multiple linear regression models based on Karlson/Holm/Breen (KHB) method were used to examine the mediating effect.

RESULTS: At baseline, 15,142 participants had no cognitive impairment, and 11,413 individuals were finally included in our analysis after 6-year follow-up. Multiple linear regression models suggested that lower perceived neighborhood physical disorder (β=0.073, P=0.033) and greater perceived neighborhood safety (β=0.350, P=0.009) were associated with better cognition. KHB test identified the significant mediating effect of loneliness on the relationships between perceived neighborhood physical disorder (β=0.011, P=0.016) and perceived neighborhood safety (β=0.023, P=0.026) and cognition.

CONCLUSIONS: Perceived neighborhood characteristics are associated with cognition among middle-aged and older American adults. Loneliness mediated associations between perceived neighborhood physical disorder and perceived neighborhood safety and cognition. This article is protected by copyright. All rights reserved.

PMID:34214209 | DOI:10.1002/gps.5595

PM R. 2021 Jul 2. doi: 10.1002/pmrj.12665. Online ahead of print.

ABSTRACT

INTRODUCTION: Open surgical trigger finger release has limited success with complications; however, percutaneous techniques have a successful alternative. There is limited understanding of the success of percutaneous trigger finger release.

OBJECTIVE: To prospectively evaluate the functional outcomes of patients with Green classification Grade 2 to 4 trigger finger treated with an ultrasound-guided micro-invasive trigger finger release using a special 18-gauge needle with a blade at the tip.

DESIGN: prospective, case-series study SETTING: This study took place at an academic institution by one sports medicine physician (REC) with subspecialty training and certification in musculoskeletal ultrasound.

PATIENTS: Sixty patients (79 cases) met criteria and agreed to participate in this study; 19 patients had multiple fingers treated. Average patient age was 62.8 years (SD10.2). Average trigger finger severity diagnosis was Grade 3.

INTERVENTIONS: Patients were treated with an ultrasound-guided micro-invasive trigger finger release using a special 18-gauge needle with a blade at the tip.

MAIN OUTCOME MEASUREMENTS: QuickDASH, NRS, and Nirschl scores were captured pre-procedure, at various time points, and at final follow-up. Changes between pre-procedure and final follow-up were analyzed by paired t-test (p<0.05). Differences were also analyzed between finger, grade level, and sex by repeated measures ANOVA’s (p<0.05).

RESULTS: No adverse events were documented peri-operatively or post-operatively. Average follow-up time was 18.4 months (SD 4.6). At final follow-up, 100% of patients reported no recurrence of catching/locking, 97% had complete resolution of symptoms and significant improvement in QuickDASH scores, and 99% required no further treatment. All measurements showed a decrease in pain and symptoms over time. The improvements in QuickDASH score, NRS and Nirschl scale, and the resolution of mechanical symptoms were all statistically significant.

CONCLUSION: Ultrasound-guided release using the 18-gauge needle with a blade provides significant functional improvement and full resolution of mechanical symptoms with minimal adverse events. This article is protected by copyright. All rights reserved.

PMID:34213082 | DOI:10.1002/pmrj.12665