Tag: pubmed

J Pak Med Assoc. 2024 Nov;74(11 (Supple-12)):S6-S10. doi: 10.47391/JPMA.AKU-EPP-03.

ABSTRACT

OBJECTIVE: To investigate private General Practitioners’ (GPs) interest in continuous professional development (CPD), with a focus on ethical practices.

METHOD: A mixed method study design conducted a cross-sectional survey of registered private GPs (n=419) in Karachi was conducted in the year 2022 on their professional and ethical practices with perspectives on engagement in training in the year 2022. Qualitative interviews were conducted with 28 GPs to get a deeper understanding of their views on professional development.

RESULTS: The median age of participants was 55 years (IQR 48-63 years) and 361 (86.2%) were males. The median number of years of professional experience was 31.0 years (IQR 24-37 years). It was observed that 116 (27.6%) of GPs saw more than 50 patients per day, and 377 (90%) met with pharmaceutical sales representative (PSR) regularly. Reported awareness of guidelines on ethical practices was 325 (77.6.0%), and willingness to sign a pledge committing to a code of ethics and to be part of a professional network of ethical doctors was high, 389 (~93.0%). However, both qualitative and quantitative data indicated that GPs had limited time for training, despite the interest in filling gaps in knowledge about ethical practice.

CONCLUSIONS: Most GPs were willing to engage in CPD activities with a focus on ethics. Many GPs met regularly with PSRs, and CPD may reduce the pharmaceutical industry influence on their prescribing practices.

PMID:39648169 | DOI:10.47391/JPMA.AKU-EPP-03

J Int AIDS Soc. 2024 Dec;27(12):e26395. doi: 10.1002/jia2.26395.

ABSTRACT

INTRODUCTION: Disengagement and re-engagement with antiretroviral therapy (ART) are common in South Africa, but routine monitoring is insufficient to inform policy development. To address this gap, Anova implemented the 2020 National Adherence Guidelines’ re-engagement standard operating procedure (re-engagement SOP) and collected additional data to describe the characteristics of re-engagement visits to inform HIV programmes.

METHODS: Between July and December 2022, we conducted a study at nine primary healthcare facilities in Johannesburg. Staff were trained on the re-engagement SOP and provided with job aides to support implementation. Administration clerks categorized visits based on the time elapsed since the missed appointment: ≤14days and >14 days, with the latter identified as re-engaging. For these clients, clinicians filled out “re-engagement clinical assessment forms” that included visit dates, both clinician-assessed and self-reported treatment interruptions, and clinical details. Data on missed appointments and previous viral loads were extracted from medical records. The information was entered into REDCap. We present data from three out of the nine facilities, selected for their comprehensive data collection and high coverage of all re-engaging clients.

RESULTS: A total of 2342 clients returned following a missed scheduled appointment. The majority, 1523 (65%), missed their appointments by ≤ 14 days, while 819 (35%) were >14 days late (re-engaging). Among those re-engaging, 635 (78%) re-engagement clinical assessment forms were completed. A missed appointment date was available for 623 with 25% (n = 161) returning 2-4 weeks late, 47% (n = 298) 4-12 weeks and 26% (n = 164) >12 weeks late. Self-reported ART interruption, available for 89% (567/635), indicated the majority (54%, n = 304) experienced no interruption. Clinical concerns were identified in 65 (10%) cases. A majority (79%, 504/635) had prior viral load results, with 73% (370/504) below 50 copies/ml.

CONCLUSIONS: Clients frequently return to care shortly after missed appointments. Despite missing scheduled ART refill dates, many report not interrupting treatment, either having treatment on hand or sourcing ART elsewhere. Most re-engaging clients were adherent prior to disengagement, and clinical concerns are rare. A differentiated service delivery approach, prioritizing flexibility and reduced healthcare burden, is required to support client’s needs and preferences at re-engagement.

PMID:39648158 | DOI:10.1002/jia2.26395

Aust Health Rev. 2024 Dec 9. doi: 10.1071/AH24191. Online ahead of print.

ABSTRACT

ObjectiveAllied health workforce planning faces challenges because of insufficient metrics that accurately reflect population need for services. This paper presents a method and proof-of-concept in the podiatry profession for developing population-based need indicators and indices suitable for allied health workforce planning and comparative benchmarking.MethodsPopulation-based indicators of podiatry need were selected and combined into an index of need by Statistical Area Level 3 (SA3) in Australia. Medicare patient age and sex distributions for relevant item numbers were used to determine the inclusion of specific population age groups and sex as indicators. Other indicators included diabetes, socioeconomic status, and Aboriginal and Torres Strait Islander status. The need index was calculated based by aggregating these indicators at the SA3 level. The resulting need index was compared with podiatry supply (per capita clinician counts) using a population-weighted correlation coefficient (pwCorr).ResultsAnalysis of Medicare usage data led to the inclusion of indicators: population aged 65 and over, and female gender. The need index had a small but significant negative correlation with supply at the SA3-level (pwCorr =-0.12, P=0.03) and positively, but not significantly, correlated at the state/territory-level (pwCorr=0.42, P=0.30).ConclusionsDeveloping profession-specific population-based need indices provides a valuable tool for allied health workforce planners to benchmark need and supply within professions. Combining single need indicators with supply metrics offers a concise framework for effective workforce planning and advocacy.

PMID:39648145 | DOI:10.1071/AH24191

Abdom Radiol (NY). 2024 Dec 8. doi: 10.1007/s00261-024-04701-1. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the influence of a micro-enema on diagnostic performance, submucosal width, reader confidence, and tumor conspicuity using MRI to stage early rectal cancers (ERC).

METHODS: In this single-center study, we consecutively included 50 participants with assumed ERC who all completed MRI with (MRin) and without (MRex) a micro-enema. The diagnostic performance was recorded for two experienced radiologists using histopathology as the gold standard. In addition, the width of the submucosa in the tumor-bearing wall, reader confidence for T-staging, and tumor conspicuity were assessed. Significance levels were calculated using McNemar’s test (diagnostic performance) and Wilcoxon’s signed-rank test (reader confidence, submucosal width, and conspicuity). Interreader agreement was assessed using kappa statistics.

RESULTS: Sensitivity/specificity were for Reader1 91%/87% for both MRex and MRin and for Reader2 74%/87% and 89%/87%, both readers p > 0.05. The micro-enema induced a significant widening of the submucosa, p < 0.001, with a mean increase of 2.2/2.8 mm measured by Reader1/Reader2. Reader confidence in T-staging and tumor conspicuity increased for both readers, p < 0.005. The proportion of tumors with both correct staging and high reader confidence increased from 58% (29/50) to 80% (40/50) (p = 0.04) for Reader1 and from 42% (21/50) to 72% (36/50) (p = 0.002) for Reader2. Interreader agreement increased from moderate (kappa 0.58) to good (kappa 0.68).

CONCLUSION: The micro-enema significantly increased the submucosal width in the tumor-bearing wall, reader confidence, and tumor conspicuity and improved interreader agreement from moderate to good. Sensitivity and specificity in T-staging did not improve, but there was a significant increase in the proportion of tumors staged with both high confidence and correct T-stage.

PMID:39645641 | DOI:10.1007/s00261-024-04701-1

Eur Radiol. 2024 Dec 8. doi: 10.1007/s00330-024-11209-1. Online ahead of print.

ABSTRACT

OBJECTIVES: Recent studies suggest the existence of an idiopathic pulmonary arterial hypertension (IPAH) phenotype affecting mostly patients with a smoking history, characterised by low diffusion capacity for carbon monoxide (D_LCO) without clinically significant emphysema. This study’s objective was to test the hypothesis of a loss of pulmonary capillaries as an underlying mechanism by comparison to other patient groups with and without pulmonary hypertension (PH).

MATERIALS AND METHODS: Between March 2019 and June 2023, patients of four groups were recruited for this observational study: IPAH with preserved (1) and low D_LCO (2), combined pulmonary fibrosis and emphysema with PH (3), and emphysema without PH (4). Patients underwent clinical CT and ¹²⁹Xe MRI including dissolved-phase imaging yielding the ratio of ¹²⁹Xe in red blood cells and membrane tissues (RBC-M), chemical shift saturation recovery for determining RBC fraction η and diffusion-weighted imaging yielding surface-volume ratio. Kruskal-Wallis tests were used for statistical analysis.

RESULTS: Twenty-nine participants were recruited, of which 22 (age 64 ± 10, 11 male, 5/5/7/5 for the individual groups) could be included in the analysis. RBC-M and η were reduced in IPAH with low versus preserved D_LCO and emphysema groups (p ≤ 0.01). CT low-attenuation area percentage was not increased in IPAH with low D_LCO compared to any group. ¹²⁹Xe MRI-derived surface-volume ratio was reduced in IPAH with low versus preserved D_LCO (p = 0.04).

CONCLUSION: Results are consistent with a loss of pulmonary capillaries in patients with IPAH and low D_LCO along with destruction of alveolar tissue, likely due to early diffuse emphysema.

KEY POINTS: Question A loss of pulmonary capillaries has been suggested in patients with IPAH and low diffusion capacity without clinically significant emphysema on CT. Findings ¹²⁹Xe uptake in red blood cells and lung surface-volume ratio were reduced in IPAH patients with low compared to preserved diffusion capacity. Clinical relevance This study furthers the understanding of the underlying pathological mechanisms in IPAH with low diffusion capacity, providing evidence that loss of pulmonary capillaries is accompanied by alveolar tissue destruction despite near-normal CT.

PMID:39645621 | DOI:10.1007/s00330-024-11209-1

Drug Saf. 2024 Dec 8. doi: 10.1007/s40264-024-01502-9. Online ahead of print.

ABSTRACT

BACKGROUND: Proton pump inhibitors (PPIs) are among the most popular drugs worldwide. Yet, there are concerns on long-term safety and poor adherence to prescription guidelines. Off-label use in children and increasing maintenance use in older adults may be particularly worrisome.

OBJECTIVES: To assess differences in PPI use by age, sex calendar year and PPI type, and to explore potential underlying indications (ulcerogenic drugs, and indications) in Sweden.

METHODS: Proton pump inhibitor drug utilisation study based on the Swedish nationwide prescribed drug (2006-2023) and patient registries (2006-2022).

RESULTS: Proton pump inhibitors were used by 14.4% (women) and 10.5% (men) of adults; and 1.0-1.5% of children and adolescents (aged < 20 years). Proton pump inhibitor use was higher in women in all age-groups except small children (aged < 5 years). Proton pump inhibitor use has increased in all age groups, especially in young children (aged < 10 years) and the oldest groups (aged > 65 years). Proton pump inhibitor users aged > 85 years filled most prescriptions with an annual average of 9.5 (men), 11.6 (women) prescriptions. Most prescriptions were for omeprazole and esomeprazole: 63.7% and 23.5% in adults; 23.5% and 44.7% in children (2023). Prescriptions for other drugs for peptic ulcers/reflux became rare, with 99% of prescriptions in this category being PPIs by 2023. Gastro-intestinal diagnoses were predominantly recorded in men, became less prevalent and only explained part of PPI use, while ulcerogenic drugs were common (particularly in women), suggesting PPIs are regularly used for gastroprotection.

CONCLUSION: Proton pump inhibitor use has doubled in children and increased 50% in adults over the study period, in both sexes, while recorded gastrointestinal indications decreased. Alternative therapies were rarely prescribed in Sweden.

PMID:39645619 | DOI:10.1007/s40264-024-01502-9

Ann Noninvasive Electrocardiol. 2025 Jan;30(1):e70032. doi: 10.1111/anec.70032.

ABSTRACT

INTRODUCTION: Early repolarization (ER) is an electrocardiographic pattern characterized by J-point and ST-segment elevation, frequently observed in athletes. Initially deemed benign, recent studies suggest a possible association between ER and increased risks of cardiac arrhythmias and sudden cardiac death, necessitating a thorough examination of its clinical implications in athletes.

METHODS: A comprehensive literature review was conducted using MEDLINE (via PubMed) and EMBASE databases, focusing on articles related to ER in athletes. Search terms included “early repolarization,” and relevant studies were selected based on their focus on athletic populations. A total of 22 articles were included for detailed analysis.

RESULTS: The review encompassed 22 studies with a combined total of 44,326 athletes, revealing an overall mean ER prevalence of 31.6 ± 17.6 (p < 0.001). Most common location in the inferolateral region at 32.28%. The prevalence varied significantly across studies, ranging from 7% to 89%, influenced by factors such as age, gender distribution, and athletic discipline. Male athletes exhibited a higher incidence of ER compared with females, and endurance athletes showed a greater prevalence than strength athletes.

CONCLUSION: ER is notably prevalent among athletes, especially males and those engaged in endurance sports. Current studies do not establish a direct association between ER and increased mortality in athletes. Further research is essential to refine risk stratification criteria and develop appropriate management strategies to ensure athlete safety while maintaining optimal performance levels.

PMID:39645598 | DOI:10.1111/anec.70032

Ann Noninvasive Electrocardiol. 2025 Jan;30(1):e70031. doi: 10.1111/anec.70031.

ABSTRACT

QT/QTc prolongation is associated with an increased risk for torsade de pointes. In at-risk hospitalized patients, it is common to obtain a standard 12-lead electrocardiogram (ECG) for this assessment, but this interrupts patient care. Our hospital recently introduced bedside monitors in the intensive care unit (ICU) with continuous QT/QTc software. However, only four of the seven available ECG leads are used.

PURPOSE: Evaluate the agreement between computerized QT/QTc measurements from the bedside monitor (four leads) and a time-matched standard 12-lead ECG.

DESIGN: Prospective observational study in three adult ICUs.

METHODS: QT/QTc measurements were obtained from a convenience sample, and the two ECG types were ≤ 30 min apart. Agreement was evaluated using Bland-Altman analysis.

RESULTS: A total of 120 patients were evaluated for inclusion, and 60 (50%) had a 12-lead ECG for comparison. The mean bias difference for QT measurements was not statistically different (β = -2.47, 95% CI = 5.50 to -11.05; p = 0.44; limits of agreement (LOA) = -64.37 to 59.44). Similar non-statistical differences were observed for QTc (β = -3.20, 95% CI = 5.50 to -11.05; p = 0.44; LOA = -67.43 to 61.03).

CONCLUSION: There was good agreement for both QT and QTc measurements between the two methods. These pilot data are promising and suggest QT/QTc measurements from bedside monitors (four leads) may be an acceptable alternative to obtaining additional standard 12-lead ECGs. Given that half of the ICU patients screened did not have a 12-lead ECG recorded, bedside monitor QT/QTc’s could identify at-risk patients. However, an evaluation in a larger sample and non-ICU patients is warranted.

PMID:39645597 | DOI:10.1111/anec.70031

Iran Biomed J. 2024 Dec 1;28(7):3.

ABSTRACT

INTRODUCTION: As climate change continues to reshape our environment, accurately forecasting air quality becomes essential for developing effective public health and environmental strategies. This study investigates changes in particulate matter (PM10) concentrations under the Shared Socioeconomic Pathways of the Climate Model Intercomparison Project Phase 6 (CMIP6).

METHODS AND MATERIALS: Historical climatic data (1998-2014) were collected to establish baseline conditions, and vital climatic variables-maximum and minimum temperatures, precipitation, and radiation-were gathered between 2013 and 2022 from the Iran Meteorological Organization. The Long Ashton Research Station Weather Generator (LARS-WG 6.0) software was used to perform statistical downscaling, generating high-resolution time series datasets from the historical climatic data. The MIROC6 atmospheric circulation models simulated future climate scenarios using three Shared Socioeconomic Pathways (SSPs) from the sixth IPCC Assessment Report (AR6): optimistic (SSP1-2.6), intermediate (SSP2-4.5), and pessimistic (SSP3-7.0). Monthly PM10 concentrations were obtained from MODIS satellite images. An Artificial Neural Network Nonlinear Autoregressive with Exogenous Input (ANN-NARX) model was developed using the collected climatic variables as predictors, and this model was used to estimate PM10 concentrations for the period 2023-2042 under each SSP scenario.

RESULTS: In various SSP scenarios, PM10 levels were assessed between 2023 and 2042. An increase in PM10 was observed across all scenarios, particularly during the hotter months of summer and spring over the next 20 years. The SSP2-4.5 scenario showed minimal change, maintaining levels close to historical data. In contrast, SSP3-7.0 exhibited significant increases in PM10, especially during the warmer months of summer and spring. Sensitivity analysis identified radiation and maximum temperature as critical factors influencing PM10 predictions, with sensitivity plots showing a notable increase in MSE when these factors were removed. The ANN-NARX model demonstrated satisfactory performance across the training, validation, and testing sets, with RMSE values ranging from 0.15 to 0.30, MAE values from 0.10 to 0.35, and MSE values from 0.01 to 0.1, and R values from 0.91 to 0.92.

CONCLUSION AND DISCUSSION: The study concluded that PM10 concentrations in Ahvaz were significantly influenced by radiation and maximum temperature. The anticipated temperature increases under various SSP scenarios suggest a potential decline in future air quality, with expected rises in PM10 levels. These findings underscore the urgent need for effective air quality management and climate adaptation strategies in Ahvaz.

PMID:39645595

Iran Biomed J. 2024 Dec 1;28(7):2.

ABSTRACT

INTRODUCTION: Polycystic ovary syndrome (PCOS) is the most common endocrine and metabolic disorder in women of reproductive age globally. It is linked to a higher prevalence of metabolic syndrome, cardiovascular diseases, and type 2 diabetes. Time-restricted eating is a type of intermittent fasting. That is a promising strategy for weight loss and glucose and lipid metabolism improvements. However, the exact time for the restriction of food intake is controversial. It is unclear to the beginning (early TRE, eTRE) or the middle of the day (middle TRE, mTRE). So, this study aims to determine whether eTRE or mTRE is a better dietary approach to improving the metabolic disorder of polycystic ovary syndrome.

METHODS AND MATERIALS: In this clinical randomized trial, we conducted a 6-week study to compare the effects of e-TRE (8:00-18:00/n=25) and m-TRE (11:00-21:00/n=25) on anthropometric indices, insulin sensitivity, and other glycemic and lipid profiles. A total of fifty overweight or obese women, aged between 18-40 and diagnosed with PCOS by modified Rotterdam criteria, were randomly assigned to one of two groups. We evaluated changes in body weight, waist circumference (WC), body mass index (BMI), fasting blood sugar (FBS), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL). We used independent t-test and paired t-test (and their non-parametric equivalent) to analyze the differences.

RESULTS: The analyses showed that significant changes in body weight, WC, BMI, FBS, and HOMA-IR were found after 6 weeks in both intervention groups (p = 0.0001). In addition, e-TRE significantly improved fasting insulin, TC, and LDL (p = 0.0001); however, no significant relation was observed in the m-TRE group (p = 0.05). Changes in TG and HDL were not statistically significant (p = 0.05). A comparison of the two groups revealed a substantial difference in weight, BMI, FBS, TC, LDL, fasting insulin, and HOMA-IR (p = 0.05).

CONCLUSION AND DISCUSSION: Overall, our findings suggest that e-TRE is more effective than m-TRE for losing weight and reducing insulin resistance in patients with polycystic ovary syndrome. However, results on lipid profile are conflicting, and further randomized control trials are needed.

PMID:39645592