Tag: pubmed

BMC Psychol. 2024 Aug 31;12(1):462. doi: 10.1186/s40359-024-01957-6.

ABSTRACT

BACKGROUND: Physicians are inclined to resort to defensive medicine (DM) for self-protection due to the increasing potential risk of medical litigation. DM is globally prevalent and has become an impediment to the development of healthcare. However, there is a lack of validated tools specifically designed to assess DM in China. Therefore, this study aimed to evaluate the psychometric properties of the Chinese version of Defensive Medicine Scale (DMS) among clinicians to provide a practicable tool for relevant research.

METHODS: The present research consists of two phases. In Phase 1, DMS was administered to survey 327 physicians, and the collected data were obtained for item analysis and exploratory factor analysis. Phase 2 applied DMS to survey 323 physicians, from which the data was used for confirmatory factor analysis, and reliability and cross-cohort consistency tests. Moreover, the participants of Phase 2 were required to complete Workplace Well-Being Scale (WWBS), Career Commitment Scale (CCS), Occupational Disidentification Scale (ODS), Intent to Leave Scale (ILS), and Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) to test the convergent validity of DMS.

RESULTS: The Chinese version of DMS consists of 10 items divided into 2 dimensions, Positive Defensive Medicine (PDM) and Negative Defensive Medicine (NDM). The confirmatory factor analysis showed that the two-factor model fitted well (χ²/df = 2.540, RMSEA = 0.069, CFI = 0.981, IFI = 0.981, TLI = 0.971, PNFI = 0.646, PCFI = 0.654, SRMR = 0.044). Furthermore, the total score and the score of each dimension for DMS had a significant negative correlation with WWBS and CCS scores, and a significant positive correlation with ODS, ILS, and DDPRQ-10 scores. The Cronbach’s α coefficients for the total DMS and PDM and NDM dimensions were 0.917, 0.935, and 0.842, respectively; the split-half reliability coefficients were 0.922, 0.947, and 0.839, respectively. In addition, DMS showed cross-gender invariance.

CONCLUSION: The Chinese version of DMS has been demonstrated to be an effective tool to assess defensive medicine among Chinese physicians with good psychometric properties.

PMID:39217402 | DOI:10.1186/s40359-024-01957-6

J Health Popul Nutr. 2024 Aug 31;43(1):134. doi: 10.1186/s41043-024-00618-z.

ABSTRACT

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common chronic liver disease.

OBJECTIVE: This study aimed to investigate the self-management ability of patients with MASLD, analyse related factors that may affect self-management ability and evaluate the impact of this ability on readmission.

METHODS: The study recruited patients with MASLD admitted to the Department of Infectious Diseases, First Affiliated Hospital of Wenzhou Medical University, between February and October 2021 using the random sampling method. The MASLD diagnosis was based on the guidelines for the prevention and treatment of MASLD. An analysis of patients’ self-management ability was conducted using the self-management ability scale for patients with MASLD. Multiple linear regression analysis was used to analyse the factors influencing this self-management ability, and the readmission rate within 1 year was tracked. The patients were rediagnosed as having MASLD upon readmission to the hospital.

RESULTS: A total of 241 baseline data items and self-management scale scores for patients with MASLD were collected and investigated. In our study, the normal score range for the self-management scale was 31-155 points, and the self-management scale scores for patients with MASLD was 91.24 ± 16.98, with a low level of self-management accounting for 52.7% and a medium level accounting for 44.8%. The results of the multiple linear regression analysis revealed that marital status, smoking history, fatty liver severity and education were the main factors affecting self-management ability (P < 0.05). The readmission rates were 18.25%, 7.48% and 0%, respectively, after 1 year of follow-up; the difference in survival distribution was statistically significant (P < 0.05).

CONCLUSION: The self-management ability of patients with MASLD is relatively low and is primarily influenced by factors such as marital status, smoking history, the severity of fatty liver disease and level of education, which also affect the readmission rate of patients within 1 year.

PMID:39217400 | DOI:10.1186/s41043-024-00618-z

BMC Psychol. 2024 Aug 31;12(1):463. doi: 10.1186/s40359-024-01946-9.

ABSTRACT

OBJECTIVES: This study aims to investigate the links between the clinical, demographic, and psychosocial factors and cancer-related worry in patients with early-stage lung cancer after surgery.

METHODS: The study utilized a descriptive cross-sectional design. Questionnaires, including assessments of cancer-related worry, symptom burden, illness perception, psychological resilience, coping modes, social support and participant characteristics, were distributed to 302 individuals in early-stage lung cancer patients after surgery. The data collection period spanned from January and October 2023. Analytical procedures encompassed descriptive statistics, independent Wilcoxon Rank Sum test, Kruskal-Wallis- H- test, Spearman correlation analysis, and hierarchical multiple regression.

RESULTS: After surgery, 89.07% had cancer-related worries, with a median (interquartile range, IQR) CRW score of 380.00 (130.00, 720.00). The most frequently cited concern was the cancer itself (80.46%), while sexual issues were the least worrisome (44.37%). Regression analyses controlling for demographic variables showed that higher levels of cancer-related worry (CRW) were associated with increased symptom burden, illness perceptions, and acceptance-rejection coping modes, whereas they had lower levels of psychological resilience, social support and confrontation coping modes, and were more willing to obtain information about the disease from the Internet or applications. Among these factors, the greatest explanatory power in the regression was observed for symptom burden, illness perceptions, social support, and sources of illness information (from the Internet or applications), which collectively explained 52.00% of the variance.

CONCLUSIONS: Healthcare providers should be aware that worry is a common issue for early stage lung cancer survivors with a favorable prognosis. During post-operative recovery, physicians should identify patient concerns and address unmet needs to improve patients’ emotional state and quality of life through psychological support and disease education.

PMID:39217397 | DOI:10.1186/s40359-024-01946-9

Crit Care. 2024 Aug 31;28(1):287. doi: 10.1186/s13054-024-05072-1.

ABSTRACT

BACKGROUND: The decision to forgo life-sustaining treatment in intensive care units (ICUs) is influenced by ethical, cultural, and medical factors. This study focuses on a population of patients with hospital-acquired bloodstream infections (HABSI) to investigate the association between patient, pathogen, center and country-level factors and these decisions.

METHODS: We analyzed data from the EUROBACT-2 study (June 2019-January 2021) from 265 centers worldwide, focusing on non-COVID-19 patients who died in the hospital or within 28 days after HABSI. We assessed whether death was preceded by a decision to forgo life-sustaining treatment, examining country, center, patient, and pathogen variables. To assess the association of each potentially important variable with the decision to forgo life-sustaining treatment, univariable mixed logistic regression models with a random center effect were performed.

RESULTS: Among 1589 non-COVID-19 patients, 519 (32.7%) died, with 191 (36.8%) following a decision to forgo life-sustaining treatment. Significant geographical differences were observed, with no reported decisions to forgo life-sustaining treatment in African countries and fewer in the Middle East compared to Western Europe, Australia, and Asia. Once a center effect was considered, only health expenditure (Odds ratio 1.79, 95%CI: 1.45-2.21, p < 0.01) and age (Odds ratio 1.02, 95%CI: 1.002-1.05, p = 0.03) were significantly associated with decisions to forgo life-sustaining treatment, while other patient and pathogen factors were not.

CONCLUSION: Economic and regional disparities significantly impact end-of-life decision-making in ICUs. Global policies should consider these disparities to ensure equitable end-of-life care practices.

PMID:39217394 | DOI:10.1186/s13054-024-05072-1

Eur J Med Res. 2024 Aug 31;29(1):444. doi: 10.1186/s40001-024-02024-x.

ABSTRACT

BACKGROUND: Post-extubation dysphagia (PED) emerges as a frequent complication following endotracheal intubation within the intensive care unit (ICU). PED has been strongly linked to adverse outcomes, including aspiration, pneumonia, malnutrition, heightened mortality rates, and prolonged hospitalization, resulting in escalated healthcare expenditures. Nevertheless, the reported incidence of PED varies substantially across the existing body of literature. Therefore, the principal objective of this review was to provide a comprehensive estimate of PED incidence in ICU patients undergoing orotracheal intubation.

METHODS: We searched Embase, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science, Technology Journal Database (VIP), and SinoMed databases from inception to August 2023. Two reviewers independently screened studies and extracted data. Subsequently, a random-effects model was employed for meta-statistical analysis utilizing the “meta prop” command within Stata SE version 15.0 to ascertain the incidence of PED. In addition, we performed subgroup analyses and meta-regression to elucidate potential sources of heterogeneity among the included studies.

RESULTS: Of 4144 studies, 30 studies were included in this review. The overall pooled incidence of PED was 36% (95% confidence interval [CI] 29-44%). Subgroup analyses unveiled that the pooled incidence of PED, stratified by assessment time (≤ 3 h, 4-6 h, ≤ 24 h, and ≤ 48 h), was as follows: 31.0% (95% CI 8.0-59.0%), 28% (95% CI 22.0-35.0%), 41% (95% CI 33.0-49.0%), and 49.0% (95% CI 34.0-63.0%), respectively. When sample size was 100 < N ≤ 300, the PED incidence was more close to the overall PED incidence. Meta-regression analysis highlighted that sample size, assessment time and mean intubation time constituted the source of heterogeneity among the included studies.

CONCLUSION: The incidence of PED was high among ICU patients who underwent orotracheal intubation. ICU professionals should raise awareness about PED. In the meantime, it is important to develop guidelines or consensus on the most appropriate PED assessment time and assessment tools to accurately assess the incidence of PED.

PMID:39217392 | DOI:10.1186/s40001-024-02024-x

J Prosthodont. 2024 Aug 31. doi: 10.1111/jopr.13934. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to evaluate the impact of mechanical roughening, adhesive applications, and aging on the bonding between CAD-CAM denture base materials with distinct chemical contents and hard relining material.

MATERIALS AND METHODS: A total of 300 denture base specimens were produced by additive, subtractive, and conventional heat-polymerization techniques (N = 100). The specimens have been classified into five subgroups based on the particular surface treatments administered (n = 20): (1) Hard relining material’s adhesive application (control); (2) Tungsten carbide bur application for 1 min, and hard reline material’s adhesive application; (3) Airborne-particle abrasion (APA) with 110 μm Al₂O₃, and hard reline material’s adhesive application; (4) Scotchbond Universal application; and (5) Visio.link application. Representative specimens from each subgroup were examined under a Scanning Electron Microscope (SEM). Subsequently, self-cure hard relining material was condensed in the center of the specimens. Half of the specimens were thermally aged with 5000 cycles at 5°C-55°C. The shear bond strength (SBS) test was performed, and failure loads were recorded. The data was evaluated by Robust ANOVA and Bonferroni test (p < 0.05).

RESULTS: No statistically significant difference was obtained between the production techniques (p = 0.051). The lowest SBS was observed in the control group among surface treatments, while mechanical surface treatments and universal adhesive showed the highest SBS for both aged and non-aged groups. Aging caused a significant decrease for all test groups (p = 0.001).

CONCLUSIONS: Mechanical surface treatments and universal adhesive applications are more effective for maintaining adhesion across all production techniques.

PMID:39215615 | DOI:10.1111/jopr.13934

J Magn Reson Imaging. 2024 Aug 31. doi: 10.1002/jmri.29568. Online ahead of print.

ABSTRACT

BACKGROUND: Abnormalities in resting-state functional brain activity have been detected in patients with temporal lobe epilepsy (TLE). The results of individual neuroimaging studies of TLE, however, are frequently inconsistent due to small and heterogeneous samples, analytical flexibility, and publication bias toward positive findings.

PURPOSE: To investigate the most consistent regions of resting-state functional brain activity abnormality in patients with TLE through a quantitative meta-analysis of published neuroimaging data.

STUDY TYPE: Meta-analysis.

SUBJECTS: Exactly 1474 TLE patients (716 males and 758 females) from 31 studies on resting-state functional brain activity were included in this study.

FIELD STRENGTH/SEQUENCE: Studies utilizing 1.5 T or 3 T MR scanners were included for meta-analysis. Resting-state functional MRI using gradient echo-planar imaging, T1-weighted imaging.

ASSESSMENT: PubMed, Web of Science, Chinese National Knowledge Infrastructure, and WanFang databases were searched to identify studies investigating amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), and regional homogeneity (ReHo) at the whole-brain level between patients with TLE and healthy controls (HCs).

STATISTICAL TESTS: Seed-based d Mapping with Permutation of Subject Images, standard randomization tests and meta-regression analysis were used. Results were significant if P < 0.05 with family-wise error corrected.

RESULTS: Patients with TLE displayed resting-state functional brain activity which was a significant increase in the right hippocampus, and significant decrease in the right angular gurus and right precuneus. Additionally, the meta-regression analysis demonstrated that age (P = 0.231), sex distribution (P = 0.376), and illness duration (P = 0.184), did not show significant associations with resting state functional brain activity in patients with TLE.

DATA CONCLUSION: Common alteration patterns of spontaneous brain activity were identified in the right hippocampus and default-model network regions in patients with TLE. These findings may contribute to understanding of the underlying mechanism for potentially effective intervention of TLE.

TECHNICAL EFFICACY STAGE: Stage 2.

PMID:39215606 | DOI:10.1002/jmri.29568

Eur Heart J. 2024 Aug 31:ehae602. doi: 10.1093/eurheartj/ehae602. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Circulating proenkephalin (PENK) is a stable endogenous polypeptide with fast response to glomerular dysfunction and tubular damage. This study examined the predictive value of PENK for renal outcomes and mortality in patients with acute coronary syndromes (ACS).

METHODS: Proenkephalin was measured in plasma in a prospective multicentre ACS cohort from Switzerland (n=4787) and in validation cohorts from the UK (n=1141), Czechia (n=927), and Germany (n=220). A biomarker-enhanced risk score (KID-ACS score) for simultaneous prediction of in-hospital acute kidney injury (AKI) and 30-day mortality was derived and externally validated.

RESULTS: On multivariable adjustment for established risk factors, circulating PENK remained associated with in-hospital AKI (per log2 increase: adjusted odds ratio [OR] 1.53, 95% confidence interval [CI] 1.13-2.09, P=0.007) and 30-day mortality (adjusted hazard ratio [HR] 2.73, 95% CI 1.85-4.02, P<0.001). The KID-ACS score integrates PENK and showed an area under the receiver operating characteristic curve (AUC) of 0.72 (95% CI 0.68-0.76) for in-hospital AKI, and of 0.91 (95% CI 0.87-0.95) for 30-day mortality in the derivation cohort. Upon external validation, KID-ACS achieved similarly high performance for in-hospital AKI (Zurich: AUC 0.73, 95% CI 0.70-0.77; Czechia: AUC 0.75, 95% CI 0.68-0.81; Germany: AUC 0.71, 95% CI 0.55-0.87) and 30-day mortality (UK: AUC 0.87, 95% CI 0.83-0.91; Czechia: AUC 0.91, 95% CI 0.87-0.94; Germany: AUC 0.96, 95% CI 0.92-1.00) outperforming the CA-AKI score and the GRACE 2.0 score, respectively.

CONCLUSIONS: Circulating PENK offers incremental value for predicting in-hospital AKI and mortality in ACS. The simple 6-item KID-ACS risk score integrates PENK and provides a novel tool for simultaneous assessment of renal and mortality risk in patients with ACS.

PMID:39215600 | DOI:10.1093/eurheartj/ehae602

Eur J Pain. 2024 Aug 31. doi: 10.1002/ejp.4719. Online ahead of print.

ABSTRACT

BACKGROUND: Sensory profiling in neuropathic pain using quantitative sensory testing (QST) has not been extended to central neuropathic pain due to spinal cord injury (SCI). This study aims to fill this gap by evaluating sensory profiles in patients with neuropathic SCI pain.

METHOD: We retrospectively analysed consecutive QST data from 62 patients with neuropathic spinal cord injury pain (SCIP), following the German Research Network on Neuropathic Pain protocol. The study included at-level and below-level SCIP due to a spinal cord lesion, and at-level SCIP following a cauda equina lesion. QST parameters were compared between diagnostic groups. QST profiles of below-level SCIP (central neuropathic pain) were manually assigned to sensory phenotypes based on literature and expert opinion.

RESULTS: No statistical difference in QST parameters between pain diagnoses was found. For central neuropathic pain (below-level SCIP), three phenotypes were descriptively observed: loss of function (59%), thermal and mechanical hyperalgesia combination (16%), and mechanical hyperalgesia (19%). The remaining 5% of patients did not fit a common pattern. There was no statistical difference in clinical and psychological variables between phenotypes. In a subgroup analysis, the loss of function phenotype weakly correlated with older age, longer time since injury, and longer pain duration.

CONCLUSIONS: Here, we capture sensory phenotypes of central neuropathic pain following SCI. The limited sample size, high rate of missing values, and the retrospective nature of the study mean that results should be seen as strictly exploratory. Further research should replicate these findings and explore the significance of phenotypes.

SIGNIFICANCE STATEMENT: The evaluation of sensory phenotypes by quantitative sensory testing in central neuropathic pain due to SCI adds a new perspective on sensory phenotypes in comparison to peripheral neuropathic pain. The described thermal and mechanical hyperalgesia combination might represent involvement of the spinothalamic tract. In addition, there was a trend towards older age and longer time since injury in patients with loss of function.

PMID:39215588 | DOI:10.1002/ejp.4719

J Sep Sci. 2024 Sep;47(17):e2400421. doi: 10.1002/jssc.202400421.

ABSTRACT

Shaoyao Gancao Decoction (SGD), a traditional Chinese medicine, has been proven to have a good liver protection effect, but the mechanism and pharmacodynamic substances of SGD in the treatment of acute liver injury are still unclear. In this study, an ultra-high-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry (UHPLC-Q-TOF-MS) method was established to characterize 107 chemical components of SGD and 12 compounds absorbed in rat plasma samples after oral administration of SGD. Network pharmacology was applied to construct a component-target-pathway network to screen the possible effective components of SGD in acute liver injury. Using lipidomics based on UHPLC-Q-TOF-MS coupled with a variety of statistical analyses, 20 lipid biomarkers were screened and identified, suggesting that the improvement of acute liver injury by SGD was involved in cholesterol metabolism, glycerol-phospholipid metabolism, sphingolipid signaling pathways and fatty acid biosynthesis. In addition, the UHPLC-tandem MS method was established for pharmacokinetics analysis, and 10 potential active components were determined simultaneously within 12 min through the optimization of 0.1% formic acid water and acetonitrile as a mobile phase system. A Pharmacokinetics study showed that paeoniflorin, albiflorin, oxypaeoniflorin, liquiritigenin, isoliquiritigenin, liquiritin, ononin, formononetin, glycyrrhizic acid, and glycyrrhetinic acid as the potential active compounds of SGD curing acute liver injury.

PMID:39215583 | DOI:10.1002/jssc.202400421