Tag: pubmed

Adv Emerg Nurs J. 2024 Nov 26. doi: 10.1097/TME.0000000000000552. Online ahead of print.

ABSTRACT

Mass gathering events can greatly impact overburdened emergency medical service systems and emergency departments, which frequently experience staffing shortages and overcrowding. Nurse practitioners (NPs) were introduced into an event medicine team at mass gatherings to reduce emergency transports to local emergency departments as well as offering a “treat and release” disposition for patients presenting to medical tents. This study aimed to examine the impact of NPs at mass gathering events; 147 chart reviews were performed from 05/01/2023 to 09/30/2023 for all patients assessed by an NP at events staffed by an event medicine team; 60% of patients assessed by an NP were treated and released from the event, potentially reducing the number of patient transports and emergency department visits considerably. NPs can provide higher levels of care at events, treating common complaints such as heat-related illness, nausea, vomiting, minor trauma, and laceration repairs. Although this study did not compare data from events where NPs were not present versus when they were utilized to grasp the statistical impact their presence has had since their introduction to the team model, the study clearly shows the benefits NPs bring to mass gathering medical care. This is significant for emergency NPs as this research validates the need to include these providers in this new setting and role in which they can practice. More research is needed to compare patient outcomes with and without NPs present.

PMID:39591635 | DOI:10.1097/TME.0000000000000552

Ophthalmic Surg Lasers Imaging Retina. 2024 Nov 1:1-6. doi: 10.3928/23258160-20241114-01. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: This study compares the ability of resident ophthalmologists to identify neovascularization (NV) in patients with proliferative diabetic retinopathy (PDR) using widefield swept-source optical coherence tomography angiography (SS-OCTA) and fluorescein angiography (FA).

PATIENTS AND METHODS: Fluorescein angiography and SS-OCTA images were scrambled to create a grading set consisting of 1) early and late phase FA images, 2) B-scan videos, and 3) vitreoretinal interface (VRI) slab. Participants were asked to identify NV.

RESULTS: Twelve resident physicians participated in the study. Resident physicians correctly identified 75.6% of NV using FA, 65.3% of NV using SS-OCTA B-scans, and 90.7% of NV using the SSOCTA VRI slab. There was no statistically significant difference in participants’ ability to detect NV across imaging modalities (P = 0.08).

CONCLUSION: Detection rates of NV using SS-OCTA were comparable to that of using FA. Results suggest that SS-OCTA may be an appropriate imaging modality for detection of NV in PDR patients. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

PMID:39591626 | DOI:10.3928/23258160-20241114-01

JMIR Form Res. 2024 Nov 26;8:e60674. doi: 10.2196/60674.

ABSTRACT

BACKGROUND: Inexperienced adolescent drivers are particularly susceptible to engaging in distracted driving behaviors (DDBs) such as texting while driving (TWD). Traditional driver education approaches have shown limited success in reducing motor vehicle crashes among young drivers.

OBJECTIVE: We tested an innovative approach to help address the critical issue of DDB among teenagers. We investigated the effectiveness of using a novel virtual reality (VR) game “Distracted Navigator” to educate novice teenage drivers about DDB.

METHODS: The game consisted of maneuvering a spaceship around asteroids while engaging in simulated DDB (eg, inputting numbers into a keypad). A physician-facilitated discussion, based on the theory of planned behavior, linked gameplay to real-life driving. Teenagers were recruited for the in-person study and randomly assigned at the block level to intervention (VR gameplay or discussion) and control groups (discussion only), approximating a 2:1 ratio. Unblinded, bivariate statistical analyses (all 2-tailed t tests or chi-square tests) and regression analyses measured programming impact on TWD-related beliefs and intentions. Content analysis of focus group interviews identified thematic feedback on the programming.

RESULTS: Of the 24 participants, 15 (63%) were male; their ages ranged from 14 to 17 (mean 15.8, SD 0.92) years, and all owned cell phones. Compared to the control group (n=7, 29%), the intervention group (n=17, 71%) was more likely to report that the programming had positively changed how they felt about texting and driving (?²₁₈=-8.3; P=.02). However, specific TWD attitudes and intentions were not different by treatment status. Irrespective of treatment, pre- and postintervention scores indicated reduced confidence in safely TWD (ie, perceived behavioral control; β=-.78; t₄₆=-2.66; P=.01). Thematic analysis revealed the following: (1) the VR gameplay adeptly portrayed real-world consequences of texting and driving, (2) participants highly valued the interactive nature of the VR game and discussion, (3) both the VR game and facilitated discussion were deemed as integral and complementary components, and (4) feedback for improving the VR game and discussion.

CONCLUSIONS: Our findings show that the novel use of immersive VR experiences with interactive discussions can raise awareness of DDB consequences and is a promising method to enhance driving safety education. The widespread accessibility of VR technology allows for scalable integration into driver training programs, warranting a larger, prospective, randomized study.

PMID:39591605 | DOI:10.2196/60674

Arch Cardiol Mex. 2024;94(4):403-411. doi: 10.24875/ACM.23000203.

ABSTRACT

OBJECTIVES: Ebstein’s anomaly is a congenital defect characterized by a lack of delamination and apical displacement of the tricuspid valve, tricuspid insufficiency, right atrial enlargement, and ventricular dysfunction. To analyze the results and evolution of the different surgical strategies, data were collected from 45 patients operated on during 1990-2018. Twenty-six patients were included with a median age at initial surgery of 11.3 years (range: 13 days-18.6 years).

METHOD: Procedures were plastic 10 patients (38%), cone technique reconstruction 11 (42%), and replacement 5 (19%). Additional interventions were required in 7 patients: cavo-pulmonary anastomosis 4 and Cox-maze 4. Nine patients (34.6%) required reoperation due to severe tricuspid insufficiency. Six had previous plastic, two bioprothesis, and one, cone.

RESULTS: Overall mortality was 11.5% (3) at a median of 10.1 years post-surgery (range: 5.7-10.12) associated with arrhythmias (p = 0.05), right (p = 0.008), left (p = 0.0001) ventricular dysfunction and reoperations (p = 0.03). None were previous conus. Median follow-up was 6.5 years (range: 1-29.1). Ninety-one-point-six percent were in functional class I/II and 79.2% in sinus rhythm.

CONCLUSIONS: The results of the different classic techniques were similar, although not free of complications and reoperations. Cone reconstruction proved to be effective, with low surgical mortality, less need for reoperations, and durability in the medium term.

PMID:39591595 | DOI:10.24875/ACM.23000203

Cir Cir. 2024;92(6):751-757. doi: 10.24875/CIRU.23000024.

ABSTRACT

OBJECTIVE: To compare the costs of care and the opportunity of care for the management of grade I-II ankle sprain in two Family Medicine Units, one with rehabilitation service (FMU 13) and one without rehabilitation service (FMU 41).

METHOD: Observational analytical study, records with diagnosis of grade I-II ankle sprain attended at the FMU were included January-November 2021. Consultations were recorded in the emergency department, family medicine, rehabilitation, cabinet studies and time to grant the appointment in the rehabilitation service (opportunity of care), the Mann-Whitney U test was used to compare costs of care and timeliness of care.

RESULTS: In FMU 41, care costs were higher compared to FMU 13 ($13,990 vs $8,063); however, this difference was not significant, as was the cost of care in family medicine, rehabilitation, and opportunity of care.

CONCLUSIONS: The costs of care and the opportunity of care were similar in both models of care (FMU 13-FMU 41) of grade I-II ankle sprain.

PMID:39591581 | DOI:10.24875/CIRU.23000024

Cir Cir. 2024;92(6):741-750. doi: 10.24875/CIRU.24000184.

ABSTRACT

OBJECTIVE: Reviewing available literature regarding extranodal Rosai-Dorfman disease in the breast to explore the clinical characteristics of this disease, the described therapeutic options, and their outcomes.

METHOD: In January 2024, the PubMed, SpringerOpen, and Scopus databases were searched with the keywords “Rosai,” “Dorfman,” and “Breast.” Forty-two studies were included in the final analysis, obtaining a total of 70 reported cases of extranodal Rosai-Dorfman disease affecting the breast. Patient characteristics, mammogram descriptions, therapeutic management, and outcomes were reviewed for statistical analysis.

RESULTS: The main population consisted of females in their sixth decade of life (93%), presenting with a firm, non-tender nodule (65.7%), generally localized to one breast (72%). About 18.6% of patients had nodal or extranodal disease in other areas. Excisional biopsy was the main treatment strategy (63%) and surgical excision showed a lesser association with recurrence than incisional biopsy (p = 0.049). Most instances of disease recurrence or progression were diagnosed within the first 2 years.

CONCLUSIONS: This study revealed that surgical excision showed less association with disease recurrence or progression than expectant management. Follow-up can be conducted with a mammogram and physical examination since recurrence tends to occur locally within 2 years.

PMID:39591578 | DOI:10.24875/CIRU.24000184

Cir Cir. 2024;92(6):758-768. doi: 10.24875/CIRU.23000261.

ABSTRACT

OBJECTIVE: To compare visual acuity, refraction, Schirmer test, tear break-up time (TBUT), esthesiometry, optical quality, higher order aberrations and posterior corneal elevation measurements before and after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK).

METHOD: Paired eye, randomized, cohort study. Follow-up was performed at days 1 and 7, and at months 1, 3, 6 and 12.

RESULTS: Forty-two eyes were enrolled in the study. Over time, a difference in posterior corneal elevation was statistically significant (p < 0.01) with a greater change in patients treated with SMILE. There was no difference in corrected distance visual acuity and uncorrected distance visual acuity and cylinder between the two techniques; however, there was a statistical significant difference in spherical error and spherical equivalent (p < 0.01). There was no difference between the eyes with FS-LASIK and SMILE in the assessment regarding the TBUT, the Schirmer test and esthesiometry.

CONCLUSIONS: SMILE showed more changes in the posterior elevation with a progressive backward shift throughout time during follow-up. SMILE and FS-LASIK provides similar results in myopic patients regarding visual acuity, refraction, Schirmer test, TBUT and esthesiometry.

PMID:39591576 | DOI:10.24875/CIRU.23000261

Cir Cir. 2024;92(6):702-708. doi: 10.24875/CIRU.23000414.

ABSTRACT

OBJECTIVE: The purpose of this study was to examine the surgical treatment of two-part and three-part proximal humerus fractures utilizing two approaches.

METHOD: Study involved a total of 40 individuals. Twenty patients were treated with plates and screws and 20 with intramedullary locking nail osteosynthesis. We created 10 pairs of patients that were matched in age, gender, and fracture type, with the sole difference being the osteosynthetic material used. The mean follow-up was 4 years (1-9 years). We evaluated the results of treatment using Constant’s scoring scale.

RESULTS: The mean value of Constant’s scoring scale was 78.05 for patients treated with plates and screws and 67.55 for those treated with intramedullary stabilization. There was no statistically significant difference between the groups nor were there statistically significant differences in post-operative range of motion (ROM).

CONCLUSIONS: The results of Constant’s scoring scale were higher for patients whose fractures were stabilized with a plate and screws. The same group of patients had a higher degree of mobility and better ROM. Even while there was a general tendency toward better outcomes when using plates and screws for fixation, there was no indication as to which surgical technique offers the best results.

PMID:39591575 | DOI:10.24875/CIRU.23000414

Cir Cir. 2024;92(6):709-714. doi: 10.24875/CIRU.23000362.

ABSTRACT

OBJECTIVE: The aim of this study was to analyze the reliability of agreement between surgeons when using the Parkland Grading Scale for Acute Cholecystitis (PGS-AC).

METHODS: A total of 43 images taken out of videos of laparoscopic cholecystectomies (LCs) were collected, they were used to frame an online questionnaire that was sent to 18 surgeons and resident doctors who classified the images according to the Parkland scale criteria, followed by the evaluation of concordance between observers applying the Fleiss κ test.

RESULTS: A global Fleiss’ κ value of 0.213 was obtained, which corresponds to a low interobserver concordance. Factors such as being a surgical resident, having more than 10 years of experience performing this type of procedure, or performing more than 2 LCs per week, were related to greater concordance in diagnosis.

CONCLUSIONS: The low concordance found when using the Parkland grading scale, translates into a high interobserver variation related to multiple variables, which is why, we are not seeing the same.

PMID:39591568 | DOI:10.24875/CIRU.23000362

Cir Cir. 2024;92(6):769-775. doi: 10.24875/CIRU.23000379.

ABSTRACT

OBJECTIVE: Throughout the COVID-19 pandemic, care protocols were created to apply in hospital units and care for the vulnerable populationin. The objetive was to describe clini- cal manifestations, comorbidity and mortality in cancer patients with SARS CoV-2 infection, as well as sanitary measures carried out in COVID centers.

METHOD: Retrospective study of 1752 patients admitted to a respiratory care unit.

RESULTS: 5% of the population studied had a previous diagnosis of cancer; 59.1% were solid neoplasms and 40.9% hematologic neoplasms. Patients with cancer showed lower rates of admission to the intensive care unit (ICU) compared to patients without cancer (8% vs. 17.4%), with no differences in survival.

CONCLUSIONS: Oncology patients hospitalized with COVID-19 did not have different survival rates and were less likely to require ICU care compared to non-cancer patients, this is likely due to multidisciplinary teamwork during the pandemic.

PMID:39591561 | DOI:10.24875/CIRU.23000379