Tag: pubmed

JAMA Netw Open. 2024 Dec 2;7(12):e2450172. doi: 10.1001/jamanetworkopen.2024.50172.

ABSTRACT

IMPORTANCE: Poor-quality handoffs can lead to medical errors when transitioning patient care. Biased language within handoffs may contribute to errors and lead to disparities in health care delivery.

OBJECTIVE: To compare clinical information recall accuracy and attitudes toward patients among trainees in paired cases of biased vs neutral language in simulated handoffs.

DESIGN, SETTING, AND PARTICIPANTS: Surveys administered from April 29 to June 15 and from July 20 to October 10, 2023, included 3 simulated verbal handoffs, randomized between biased and neutral, and measured clinical information recall, attitudes toward patients, and key takeaways after each handoff. Participants included residents in internal medicine, pediatrics, and internal medicine-pediatrics and senior medical students at 2 academic medical centers in different geographic regions of the US. Data were analyzed from November 2023 to June 2024.

EXPOSURES: Each participant received 3 handoffs that were based on real handoffs about Black patients at 1 academic center. These handoffs were each randomized to either a biased or neutral version. Biased handoffs had 1 of 3 types of bias: stereotype, blame, or doubt. The order of handoff presentation was also randomized. Internal medicine and pediatrics residents received slightly different surveys, tailored for their specialty. Internal medicine-pediatrics residents received the pediatric survey. Medical students were randomly assigned the survey type.

MAIN OUTCOMES AND MEASURES: Each handoff was followed by a clinical information recall question, an adapted version of the Provider Attitudes Toward Sickle Cell Patients Scale (PASS), and 3 free-response takeaways.

RESULTS: Of 748 trainees contacted, 169 participants (142 residents and 27 medical students) completed the survey (23% overall response rate), distributed across institutions, residency programs, and years of training (95 female [56%]; mean [SD] age, 28.6 [2.3] years). Participants who received handoffs with blame-based bias had less accurate information recall than those who received neutral handoffs (77% vs 93%; P = .005). Those who reported bias as a key takeaway of the handoff had lower clinical information recall accuracy than those who did not (85% vs 93%; P = .01). Participants had less positive attitudes toward patients per PASS scores after receiving biased compared with neutral handoffs (mean scores, 22.9 [3.3] vs 25.2 [2.7]; P < .001). More positive attitudes toward patients were associated with higher clinical information recall accuracy (odds ratio, 1.12; 95% CI, 1.02-1.22).

CONCLUSIONS AND RELEVANCE: In this survey study of residents and medical students, biased handoffs impeded accurate transfer of key clinical information and decreased empathy, potentially endangering patients and worsening health disparities. Handoff standardization is critical to addressing racial bias and improving patient safety.

PMID:39688867 | DOI:10.1001/jamanetworkopen.2024.50172

JAMA Netw Open. 2024 Dec 2;7(12):e2451597. doi: 10.1001/jamanetworkopen.2024.51597.

ABSTRACT

IMPORTANCE: Cannabis use among pregnant individuals has increased. Depression and stress are frequently reported motives for cannabis use that may prolong using cannabis during pregnancy.

OBJECTIVE: To examine associations between changes in depression, stress, and self-reported prenatal cannabis use (PCU), to examine motives for PCU, and to examine whether trajectories of depression and stress vary across individuals who report using cannabis to cope with mental health symptoms and/or stress, those who use cannabis for other reasons, and those who do not report PCU.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study recruited pregnant individuals at an obstetric clinic at an academic hospital between July 2019 and January 2024 and followed them during pregnancy. Pregnant individuals with a history of lifetime cannabis use were included. Individuals reporting heavy episodic alcohol use or with other illicit drug use were excluded.

EXPOSURE: Self-reported PCU.

MAIN OUTCOMES AND MEASURES: The primary outcomes were self-reported depression (Edinburgh Postnatal Depression Scale), stress (Cohen Perceived Stress Scale), and cannabis use at each trimester during pregnancy, as well as motives for cannabis use during the first trimester (T1). Stability and changes in depression and stress scores and categorical self-reported prenatal cannabis use from T1 to the third trimester (T3) were estimated using individual linear growth curve models.

RESULTS: In this sample of 504 patients (all identified as women; median [IQR] age, 26 [18-40] years), 236 individuals (46.8%) reported PCU after pregnancy knowledge. Depression, stress, and PCU decreased from T1 to T3 (all slope estimates less than -0.29; SEs, 0.23-0.7; all P < .001). There were positive associations between depression and PCU at T1 (r = 0.17; P = .004) and in their rate of change (r = 0.18; P = .01). Only T1 stress and PCU were correlated (r = 0.14; P = .004). Participants reporting PCU for mental health reasons (137 participants [58.1%]) had the highest depression scores at each trimester; however, their rate of change in depression was statistically equivalent to those who did not use cannabis.

CONCLUSIONS AND RELEVANCE: In this cohort study of PCU, participants who used cannabis did not experience a more significant decline in stress or depression symptoms compared with those who did not use cannabis. Individuals who used cannabis for mental health reasons did not hasten a decrease in their symptoms. Health care professionals are encouraged to enhance prenatal individuals’ access to empirically supported treatments for depression and stress.

PMID:39688865 | DOI:10.1001/jamanetworkopen.2024.51597

Int J Palliat Nurs. 2024 Dec 2;30(12):636-645. doi: 10.12968/ijpn.2024.30.12.636.

ABSTRACT

BACKGROUND: Patients with cancer require emotional support in addition to specialised medical treatments for their physical ailments. The quality of nursing care, resilience and hope can influence a person’s cancer trajectory, and understanding these factors and their relationship can be influential in improving the process for these patients.

AIM: This study examined the relationship between the quality of oncology nursing care and resilience and hope in patients with cancer.

METHODS: The present study is a descriptive analytics study conducted on 160 patients with cancer from April-August 2023. The data collection tools included four questionnaires: a demographic information questionnaire, the Connor-Davidson Resilience Scale (CD-RSC), the Snyder Hope Scale, and the Oncology Nursing Care Quality Scale. The data were analysed using SPSS version 22 statistical software.

RESULTS: In examining the relationship between demographic ‘variables’ and ‘resilience’, marital status and place of residence had statistically significant correlations (P<0.05). Place of residence, education level, job and first cancer treatment (P=0.004) had statistically significant correlations with hope (P<0.05). There was no statistically significant relationship between the quality of oncology nursing (QON) and its domain with two variables: ‘resilience’ (P=0.76) and ‘hope’ (P=0.37). However, a statistically significant relationship existed between the variables ‘resilience’ and ‘hope’ (P<0.001). The linear regression model results showed that among the entered demographic variables, only the variable ‘hope’ predicted resilience (P<0.001; R=27%). Additionally, the ‘resilience’ variables (P<0.001) and the ‘first cancer treated’ variable (P=0.001; R=34%) were predictors of ‘hope’.

CONCLUSION: Given the interrelationship between ‘resilience’ and ‘hope’ for patients with cancer, it is necessary to focus on the factors that impact these qualities. In addition, paying attention to the concept of resilience can improve the level of hope in patients with cancer. Based on the results, it is recommended that interventions to increase QON in patients with cancer be planned and implemented.

PMID:39688859 | DOI:10.12968/ijpn.2024.30.12.636

Int J Palliat Nurs. 2024 Dec 2;30(12):646-652. doi: 10.12968/ijpn.2024.30.12.646.

ABSTRACT

BACKGROUND: Effective training of health professionals is essential to end-of-life care.

AIMS: To explore the level of knowledge on paediatric palliative care (PPC) of nurses in a children’s monographic hospital.

METHODS: Cross-sectional observational analytical study. A sample of 53 nurses were selected. The translated and validated Spanish version of the Palliative Care Quiz for Nurses was used.

FINDINGS: Statistically significant differences (Mann-Whitney U; p=0.0346) were found between the knowledge of nurses in non-PPC-specific wards and nurses working in PPC, with the latter having a higher level of training in PPC (Chi-square; p=0.042).

CONCLUSION: Professional experience with children with palliative needs and training seems to be related to increased knowledge of palliative care.

PMID:39688858 | DOI:10.12968/ijpn.2024.30.12.646

Pain Physician. 2024 Dec;27(10):E1073-E1083.

ABSTRACT

BACKGROUND: High-voltage (65 V) long-duration pulsed radiofrequency (HL-PRF) is an effective method for managing zoster-associated pain (ZAP), though the limited efficacy of and high recurrence rates associated with the procedure present concerns.

OBJECTIVES: This study aimed to investigate the safety and effectiveness of a higher-voltage HL-PRF treatment based on the original procedure for ZAP in the spinal area.

STUDY DESIGN: A prospective, randomized, controlled trial.

SETTING: Department of Pain Management, West China Hospital of Sichuan University.

METHODS: In this prospective trial, patients were randomly assigned to one of 2 groups. Group A received an initial voltage of 65 V, which was incrementally increased to the maximum tolerable level (<= 100 V). Group B maintained a steady voltage of 65 V throughout the treatment. The optimal puncture site was determined based on the distribution of rash and pain. With the use of a 16-slice spiral computed tomography (CT) scanner, the needle entry point, angle, and depth were calculated and marked. Under CT guidance, the needle was advanced to the upper edge of the intervertebral foramen, after which the PRF treatment instrument was connected. Accurate needle placement was confirmed through sensory and motor tests that induced a tingling sensation in the symptomatic nerve root area. Pain levels, negative emotional states, quality of life, and sleep quality were measured using the Visual Analog Scale (VAS), Brief Pain Inventory (BPI), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Pittsburgh Sleep Quality Index (PSQI), respectively. The primary endpoint was the pain score at 12 weeks after treatment. Additional data collected included medication use, hospitalization costs and duration, and any adverse reactions.

RESULTS: Sixty patients were finally analyzed. The average voltage used in Group A was 85.79 ± 2.14V. As for the primary outcome, the 12-week VAS scores of Group A were significantly lower than those of Group B (P < 0.05), with scores on the BPI, GAD-7, PHQ-9, and PSQI having notable differences (P < 0.05). A significant difference in VAS score was also observed on the first day after the 2 treatments (P < 0.05). Pregabalin consumption was lower in Group A at 12 weeks (P < 0.05). No statistical differences in the areas of rescue analgesic use, adverse reaction incidence, or economic indicators were found between the groups.

LIMITATIONS: This study took place in a single-center setting and had a short follow-up period and a relatively small number of patients.

CONCLUSIONS: Using higher voltage in original HL-PRF treatments enhances pain relief, quality of life, and emotional well-being, in addition to reducing medication dependence. Multiple sessions might be preferable to a single treatment, with no additional cost or safety risks. Larger scale, long-term studies are needed to confirm these findings and guide clinical practice.

PMID:39688827

Pain Physician. 2024 Dec;27(10):E1045-E1054.

ABSTRACT

BACKGROUND: Post dural puncture headache (PDPH) is a major challenging complication and may be a cause of morbidity after spinal anesthesia. Currently there is no definitive management for PDPH, so the search for effective treatment continues.

OBJECTIVES: Our aim was to investigate the analgesic effectiveness of oral prednisolone vs oral pregabalin for managing PDPH subsequent to spinal anesthesia for lower limb surgeries.

STUDY DESIGN: A prospective controlled double-blind randomized study.

SETTING: Academic University Hospitals.

METHODS: A total of 63 patients who had lower limb surgeries and suffered PDPH after spinal anesthesia were randomly allocated into one of 3 groups. Group C patients received conservative treatment and to maintain blinding, a tablet of vitamins was given to them twice per day for 3 days; Group P patients received conservative treatment and oral prednisolone 20 mg once daily plus one tablet of vitamins (in order to ensure blinding) for 3 days; Group G patients received oral pregabalin 150 mg twice daily for 3 days in addition to conservative treatment. The primary outcomes we measured were the Visual Analog Scale (VAS) score and modified Lybecker score. The secondary outcomes we measured were the total dose of rescue analgesia, the need for an epidural blood patch (EBP), and adverse effects from the study drugs.

RESULTS: When comparing the intensity of headaches assessed through both the VAS and the modified Lybecker score, no statistically significant disparities were observed in relation to baseline measurements. While after starting treatment by 12 hours and 24 hours, the headache intensity was statistically significantly lower in Group G compared to Group P and Group C, but there was no significant difference between Group C and Group P at 12 hours. The headache intensity was statistically significantly higher in Group C compared to Group P and Group G, but there was no significant difference between Group P and Group G at 48 hours and 72 hours. Ketorolac consumption was statistically significantly higher in group C than the other groups. However, it was statistically significantly lower in group G than group P. Only 2 patients in group C were indicated for EBP while no patients in either Groups P or G required an EBP.

LIMITATIONS: Our study’s limitations include the paucity of literature studying prednisolone and pregabalin use in PDPH, our study’s small sample size, and the lack of sufficient studies for comparing results may limit the generalization of our findings.

CONCLUSION: Both oral prednisolone and pregabalin were effective in reducing PDPH severity; oral pregabalin is superior to prednisolone.

PMID:39688824

Pain Physician. 2024 Dec;27(10):E983-E994.

ABSTRACT

BACKGROUND: The analysis of epidural procedure utilization has revealed several notable trends over recent years. Utilization increased significantly until 2004, then rose minimally until 2011, followed by gradual declines up to 2019 in the Medicare population. The COVID-19 pandemic led to a marked 19% decline in usage from 2019 to 2020. Additionally, recent studies of interventional pain management techniques showed a 28.9% reduction in use from 2019 to 2022, leading to an average annual decline of 10.9%.

OBJECTIVE: The present investigation aims to provide an updated evaluation of epidural procedure usage for chronic pain management in the U.S. Medicare population.

STUDY DESIGN: A retrospective cohort study examining utilization patterns and variables for epidural injections in the fee-for-service (FFS) Medicare population in the U.S. from 2000 to 2022.

METHODS: Data was obtained from the Centers for Medicare & Medicaid Services (CMS) master database, specifically using the physician/supplier procedure summary for 2000-2022. Episodes or procedure visits were defined as one per region using primary codes only, while services included all procedure levels and any add-on codes.

RESULTS: Between 2000 and 2010, epidural episodes rose by 6.7% annually but then declined by 3% each year from 2010 to 2019. The COVID-19 pandemic led to a 19.3% reduction in procedures from 2019 to 2020, followed by a partial recovery of 5.5% in 2021, then another 10.9% drop in 2022. During 2019-2022, lumbar interlaminar and caudal procedures decreased by 26.9%, while cervical/thoracic interlaminar procedures declined by 24.2%. By 2022, transforaminal procedures surpassed interlaminar procedures, reversing the trend from 2000.

LIMITATIONS: This analysis includes data only through 2022 and is limited to the FFS Medicare population; it does not account for Medicare Advantage Plan enrollees, who made up nearly half of Medicare participants by 2022. Additionally, the study is subject to limitations inherent in retrospective claims data analysis.

CONCLUSION: This two-decade analysis indicates significant shifts in epidural procedure utilization, with steady increases until 2010, followed by a general decline affected by COVID-19 and other contributing factors. An approximate 24% decline in epidural procedure visits for chronic spinal pain management was noted from 2019 to 2022.

PMID:39688821

Pain Physician. 2024 Dec;27(10):E979-E982.

ABSTRACT

BACKGROUND: The use of facet joint interventions for spinal pain management experienced rapid growth between 2000 and 2010, with an annual increase of 14.2%. However, this trend slowed significantly from 2010 to 2019, with a reduced growth rate of just 2.9% annually. A more recent analysis highlighted a steep decline in facet joint interventions and sacroiliac joint injections, with an overall decrease of 33.2% and an annual decline rate of 12% per 100,000 Medicare beneficiaries between 2019 and 2022.

OBJECTIVE: This study aims to update and analyze utilization patterns of facet joint interventions for chronic pain management in the U.S. Medicare population over three periods: 2000-2010, 2010-2019, and 2019-2022.

STUDY DESIGN: A retrospective cohort study analyzing utilization trends and influencing factors for facet joint interventions in the FFS Medicare population in the United States from 2000 to 2022.

METHODS: Data were obtained from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary database (2000-2022). Utilization rates were calculated based on Medicare beneficiaries for each year and expressed as procedures per 100,000 beneficiaries. Episodes or procedural visits included only primary codes, while services encompassed all procedure levels, including add-on codes.

RESULTS: Utilization patterns showed substantial fluctuations. From 2000 to 2010, facet joint intervention rates grew at 14.4% annually, slowing to 2.2% from 2010 to 2019. The COVID-19 pandemic led to a 19.3% decline in episodes. From 2019 to 2022, episodes of facet joint interventions decreased by 21.2% per 100,000 beneficiaries, while the rate of services dropped by 37%, with an annual decrease of 14.3%. Specific declines included lumbar and cervical facet joint injections (38.8% and 40.2%, respectively) and lumbosacral and cervicothoracic facet joint neurolysis (33.6% and 30.8%, respectively). The reduction in facet joint injections and nerve blocks was greater than that observed for neurolytic procedures.

LIMITATIONS: Data were limited to the FFS Medicare population and were available only through 2022, excluding patterns for Medicare Advantage Plans, which covered nearly half of Medicare enrollees in 2022. Additionally, this study shares the common limitations of retrospective claims-based reviews.

CONCLUSION: This retrospective analysis reveals a substantial decline in facet joint intervention episodes, with an overall decrease of 21.2% per 100,000 Medicare beneficiaries and an annual decline rate of 7.6% for episodes from 2019 to 2022.

PMID:39688820

J Patient Rep Outcomes. 2024 Dec 17;8(1):143. doi: 10.1186/s41687-024-00819-4.

ABSTRACT

OBJECTIVE: Translating the newly developed Empowerment Audiology Questionnaire, EmpAQ-15 to Swedish, and performing content validation on the Swedish version.

DESIGN: Best-practice principles using forward and back translations which were revised by a committee prior to field testing. Field testing was conducted by cognitive interviews with hearing-aid users talking through and rating the items in the translated questionnaire. Content validation was assessed by examining equivalence, accessibility, acceptability, comprehensiveness, and relevance of interview data. Questionnaire introduction and scoring instructions were evaluated by Swedish audiologists.

STUDY SAMPLE: Ten adult native speaking Swedish hearing aid users, recruited with purposive sampling. Maximum variation based on age, gender, hearing aid usage, and degree of hearing loss. Seven Swedish audiologists assessing instructions for result calculations.

RESULTS: The conceptual equivalence between the Swedish translation and the English original questionnaire was judged to be high overall. The instructions and majority of items were experienced as accessible, acceptable, comprehensive, and relevant. The audiologists showed that they could follow scoring instructions and reason about the results.

CONCLUSIONS: This content validity study was the first step towards a Swedish version of a self- report measure of Empowerment for people with hearing loss.

PMID:39688803 | DOI:10.1186/s41687-024-00819-4

Int Urol Nephrol. 2024 Dec 17. doi: 10.1007/s11255-024-04328-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Panurethral strictures represent the most severe form within the anterior urethral stricture spectrum, requiring more technically complex repairs and resulting in poorer outcomes compared to localized anterior urethral strictures (penile or bulbar). This abstract aims to describe the distinct characteristics of patients with panurethral strictures in a low socioeconomic status population.

METHODS: Patients presenting with localized anterior (penile or bulbar) or panurethral strictures at University Hospital in Newark, NJ, between 2021 and 2023 were retrospectively identified. Data were extracted from electronic medical records and analyzed statistically using IBM SPSS Software.

RESULTS: Among the patients, 33 had localized anterior urethral strictures, and 22 had panurethral stricture disease. Hispanic and African American patients accounted for the majority of stricture cases (63.6%), including 59% of the panurethral stricture cohort. The only statistically significant factor contributing to panurethral disease was lichen sclerosis (p < 0.05). Patients with panurethral strictures had a higher incidence of inflammatory and systemic diseases such as STDs, recurrent UTIs, diabetes, and hypertension, while those with localized anterior urethral strictures showed a higher incidence of iatrogenic factors, including prior catheterizations and transurethral surgeries. However, these factors did not reach a statistical significance. Hypospadias repair was observed in 6% of localized anterior urethral stricture cases, compared to 13.6% of panurethral stricture cases.

CONCLUSION: While iatrogenic causes remain the predominant contributors, inflammatory and systemic conditions, particularly lichen sclerosis, significantly influence the development of panurethral strictures. Early surgical intervention and better management of systemic diseases may prevent the progression of localized anterior urethral strictures to panurethral disease, but further studies utilizing larger number of patients may shed light on the significance of these systemic factors.

PMID:39688799 | DOI:10.1007/s11255-024-04328-7