Tag: pubmed

MedEdPORTAL. 2024 Dec 26;20:11473. doi: 10.15766/mep_2374-8265.11473. eCollection 2024.

ABSTRACT

INTRODUCTION: A physician’s first patient harm event oftentimes occurs during the intern year. Residents encounter and are responsible for medical errors, yet little training is offered in how to properly cope with these events. Earlier and more in-depth education about how to process patient harm events is needed.

METHODS: We developed a 110-minute workshop focused on coping strategies for patient harm events and delivered it to a cohort of fourth-year medical students during a transition-to-residency course just before graduation. The workshop emphasized interns’ increasing exposure to medical errors, how to personally process them, and how to debrief near-peers in processing them.

RESULTS: A total of 190 students participated in the workshop. Our survey response rate was 88%. Students’ confidence in defining second casualty after the workshop grew from eight responding very or extremely confident (7%) to 95 responses (87%). Comfort utilizing positive coping mechanisms improved from 14 very or extremely confident responses (12%) to 73 responses (67%). Confidence utilizing first responder structure grew from three very or extremely confident responses (3%) to 61 responses (56%). Comfort helping colleagues cope with patient harm events grew from 16 very or extremely confident responses (14%) to 78 responses (72%).

DISCUSSION: This workshop fills an important gap in UME by preparing senior-level students to resolve emotional conflict related to patient harm events. Our findings illustrate that a short-term intervention on this topic can impact students’ confidence. We believe discussion around how patient harm events emotionally impact trainees should be expanded.

PMID:39726898 | PMC:PMC11669734 | DOI:10.15766/mep_2374-8265.11473

Front Nutr. 2024 Dec 12;11:1504946. doi: 10.3389/fnut.2024.1504946. eCollection 2024.

ABSTRACT

OBJECTIVE: Inflammation and nutritional status are closely associated with the mortality risk of survivors of cardio-cerebrovascular events. This study aims to evaluate the relationship between inflammation and nutritional indices and mortality among, identifying the most predictive indices.

METHODS: This study included cohort data of the survivors of major adverse cardiovascular and cerebrovascular events (MACCE) from the National Health and Nutrition Examination Survey (NHANES) in 1999-2010. MACCE is defined as a composite of myocardial infarction, heart failure and stroke, and at least one of the three events occurs. The main outcomes were all-cause mortality and cardiovascular mortality. Kaplan-Meier analysis and receiver operating characteristic curves were used to compare the correlation between seven inflammatory nutritional indices (such as Advanced Lung Cancer Inflammation Index, ALI) and mortality among the survivors. A multivariable-adjusted Cox regression and restricted cubic splines analysis identified the most predictive index, with the optimal number of nodes determined by the Akaike information criterion. Subgroup and sensitivity analyses were conducted to assess model stability.

RESULTS: A total of 2,045 MACCE survivors were included. The higher levels of ALI and serum albumin were significantly associated with lower risks of all-cause and cardiovascular mortality among these individuals. Increases in C-reactive protein to Lymphocyte Ratio, Neutrophil to Serum Albumin Ratio, Neutrophil-to-Lymphocyte Ratio, Systemic Immune-Inflammation Index (SII), and C-reactive protein were similarly correlated with higher mortality risk. ALI outperformed other indices, displaying a distinct L-shaped nonlinear relationship with both all-cause and cardiovascular mortality among MACCE survivors, with an inflection point at 90 indicating the lowest risk. To the left of this inflection, each unit increase in ALI was associated with a 1.3% decrease in all-cause and cardiovascular mortality risk among MACCE patients. To the right, the risk might increase by 0.2%, although the change was not statistically significant. Subgroup analyses and sensitivity analyses showed that the association between ALI and risk of mortality remained stable in most MACCE survivor populations.

CONCLUSION: Routine and dynamic monitoring of ALI is helpful for clinicians to assess the mortality risk among MACCE survivors. Anti-inflammatory therapies and appropriate nutritional support are crucial for reducing mortality in these individuals.

PMID:39726875 | PMC:PMC11669911 | DOI:10.3389/fnut.2024.1504946

Front Nutr. 2024 Dec 12;11:1454286. doi: 10.3389/fnut.2024.1454286. eCollection 2024.

ABSTRACT

BACKGROUND: This systematic review and meta-analysis examine the effects of okra consumption on cardiometabolic risk factors in individuals with prediabetes and diabetes. Okra is a widely consumed vegetable with potential health benefits, and understanding its impact on metabolic parameters in these populations is important.

METHODS: A comprehensive search of the literature was conducted up to May 2024 in PubMed/Medline, Scopus, and Web of Science to find relevant randomized clinical trials (RCTs) by using following keyword: (“okra” OR “okras” OR “abelmoschus esculentus“) AND (“intervention” OR “controlled trial” OR “randomized” OR “randomized” OR “randomly” OR “clinical trial” OR “trial” OR “randomized controlled trial” OR “randomized clinical trial” OR “RCT” OR “blinded” OR “placebo” OR “Cross-Over” OR “parallel”). The selected trials were subjected to heterogeneity tests using the I² statistic. Random effects models were examined based on the heterogeneity tests, and the pooled data were calculated as weighted mean differences (WMD) with a 95% confidence interval (CI). In this meta-analysis, all the analyses were performed by using the STATA version 17 software.

RESULTS: Of the 1,339 papers, nine eligible RCTs were included in the present meta-analysis. Our findings indicated that okra consumption significantly reduced total cholesterol (TC) levels (WMD: -14.40 mg/dL; (95% CI: -20.94 to -7.86); p < 0.001), low-density lipoprotein (LDL) (WMD: -7.90 mg/dL; (95% CI: -13.30 to -2.48); p = 0.004), fasting blood glucose (FBG) (WMD: -39.58 mg/dL; (95% CI: -61.60 to -17.56); p < 0.001), and hemoglobin A1C (HbA1c) (WMD: -0.46 mg/dL; (95% CI: -0.79 to -0.13); p = 0.005). Overall effect size showed that okra intake failed to change triglycerides (TG), high-density lipoprotein (HDL), Insulin, homeostatic model assessment for insulin resistance (HOMA-IR), systolic blood pressure (SBP), diastolic blood pressure (DBP), body weight, and body Mass Index (BMI) significantly.

CONCLUSION: Okra decreased TC, LDL, FBG, and HbA1c levels in the intervention compared to the control group. A dose ≤3,000 mg/day caused a significant decrease in TG, TC, LDL, HbA1c, and a significant increase in HDL. More study is needed to determine the optimum dose and duration of intervention.

PMID:39726865 | PMC:PMC11670074 | DOI:10.3389/fnut.2024.1454286

Pain Rep. 2024 Dec 24;10(1):e1218. doi: 10.1097/PR9.0000000000001218. eCollection 2025 Feb.

ABSTRACT

INTRODUCTION: Back pain (BP) is a complex heritable trait with an estimated heritability of 40% to 60%. Less than half of this can be explained by known genetic variants identified in genome-wide association studies.

OBJECTIVES: We applied a powerful multi-trait and gene-based approach to association analysis of BP to identify novel genes associated with BP.

METHODS: Using phenotypes and imputed genotypes from the UK Biobank 500k dataset, we generated a multi-trait phenotype by combining 3 BP-related phenotypes: chronic BP, dorsalgia, and intervertebral disk disorders. We performed gene-based association analysis for 3 BP-related phenotypes and multi-trait phenotype. Conditional analysis was applied to account for the effects of genetic variants outside the gene. Finally, we replicated significantly associated genes using the FinnGen database.

RESULTS: We identified 32 genes associated with BP and replicated 16 of them. Thirteen genes were detected using the multi-trait phenotype. Seven of the detected genes, MIPOL1, PTPRC, RHOA, MAML3, JADE2, MLLT10, and RERG, were not previously reported. Several new genes are known to be associated with traits genetically correlated with BP or to be involved in pathways associated with BP.

CONCLUSION: Using new powerful methods of association analysis, we identified 7 novel genes associated with BP. Our results provide new insights into the genetics of back pain.

PMID:39726856 | PMC:PMC11671072 | DOI:10.1097/PR9.0000000000001218

Front Endocrinol (Lausanne). 2024 Dec 12;15:1468820. doi: 10.3389/fendo.2024.1468820. eCollection 2024.

ABSTRACT

BACKGROUNDS: Many pregnant women suffer from more than one pregnancy complication. However, whether those women experienced a higher risk of adverse birth outcomes is unclear. This study aims to assess the association between the comorbidity of gestational diabetes mellitus (GDM) and hypertension disorders of pregnancy (HDP) and adverse birth outcomes.

METHODS: The data was from the Zhoushan Maternal and Child Health Hospital electronic medical recorder system (EMRS) between 2015 and 2022. Multivariate linear regression model was used to analyze the association of GDM, HDP, and comorbidity with birth weight and gestational age, respectively. Multiple logistic regression model was used to analyze the association of GDM, HDP, and comorbidity with adverse birth outcomes.

RESULTS: 13645 pregnant women were included. GDM+HDP was significantly associated with a higher risk of composite adverse neonatal outcomes (OR=1.82, 95%CI: 1.02-3.04), including preterm birth, placenta previa, and/or neonatal jaundice, a higher risk of small for gestational age (SGA) (OR=2.2, 95% CI: 1.24 3.92) and large for gestational age (LGA) (OR=2.33, 95% CI: 1.64 3.31) compared with the normal group. Further analysis showed that HDP diagnosed in the 21-27^th week comorbid with GDM had the lowest gestational age at delivery (β= -1.57, P=0.0002) and birth weight (β= -189.57, P=0.0138). Moreover, combined hyperglycemia (CH) comorbid with HDP had the strongest association with reduced gestational age (β= -0.83, P=0.0021).

CONCLUSION: Pregnant women suffering from both GDM and HDP had a higher risk of adverse neonatal outcomes; hence, the prevent and treatment of GDM and HDP, especially their comorbidity, are very important for pregnant women.

PMID:39726848 | PMC:PMC11669500 | DOI:10.3389/fendo.2024.1468820

Front Endocrinol (Lausanne). 2024 Dec 12;15:1400880. doi: 10.3389/fendo.2024.1400880. eCollection 2024.

ABSTRACT

OBJECTIVE: Polycystic ovary syndrome (PCOS) is an important factor contributing to infertility in reproductive-aged women. Hyperandrogenism (HA) plays an important role in the pathogenesis of PCOS. This study was conducted to explore the follicular development and endometrial receptivity of different androgen phenotypes in reproductive-aged patients with PCOS.

METHODS: A total of 268 PCOS patients with infertility were recruited and divided into two groups according to the different androgen phenotypes in this study: abnormal menstruation and hyperandrogenism (AM-HA group, n = 127) and abnormal menstruation and polycystic ovarian morphology (AM-PCOM group, n = 141). The follicular development, endometrial receptivity, pregnancy rate, and live birth rate during the natural menstrual cycle were compared between the two groups.

RESULTS: The number of dominant follicles, number of ovulations, and normal ovulation rate in the AM-HA group were significantly lower compared with those in the AM-PCOM group (p < 0.05). The endometrial thickness (ET), endometrial volume (EV), vascularization index (VI), flow index (FI), and vascularization flow index (VFI) on days 14 to 24 of the menstrual cycle before ovulation were significantly lower in the AM-HA group than in the AM-PCOM group (p < 0.05). The endometrial VI, FI, and VFI, the integrin αvβ3, and VEGF concentrations in the uterine fluid during the implantation window were significantly lower in the AM-HA group compared with the AM-PCOM group (p < 0.05). However, no statistically significant differences were observed in the uterine artery blood flow parameters, ET and EV, between the two groups (p > 0.05). The biochemical pregnancy rate, clinical pregnancy rate, ongoing pregnancy rate, and live birth rate in the AM-HA group were significantly lower compared with those in the AM-PCOM group (p < 0.05).

CONCLUSION: PCOS patients with the AM-HA phenotype were vulnerable to ovulation disorders and impaired endometrial receptivity, which resulted in reduced pregnancy rate. Treatment with HA is likely to become an effective approach for improving endometrial receptivity and fecundity disorders in patients with PCOS.

PMID:39726841 | PMC:PMC11669509 | DOI:10.3389/fendo.2024.1400880

J Environ Manage. 2024 Dec 25;373:123850. doi: 10.1016/j.jenvman.2024.123850. Online ahead of print.

ABSTRACT

India’s progress vis-à-vis the United Nations’ Sustainable Development Goals (SDG) has stagnated since 2020. The consequences of the non-attainment of the SDGs can be severe. Therefore, questions arise as to what steps must be taken to accelerate progress in India’s SDG attainment. Increased household-level adaptive capacity may accelerate progress in SDG attainment. However, the scholarly literature is characterized by an inadequate understanding of the relationship between adaptive capacity and SDG attainment. Therefore, this study analyzes how household adaptive capacity affects the local attainment of SDGs in India by analyzing household data using advanced statistical techniques. The independent variable, household adaptive capacity, was measured using a locally contextualized composite index. A regression analysis of 38 models on the local attainment of 10 targets of 7 different SDGs (1, 2, 4, 5, 8, 12, and 16) suggests that higher household-level adaptive capacity may be associated with an increased potential for local SDG attainment in India. Caste identity was also statistically significant in several of the models, which suggests that caste dynamics may play an important role in local SDG attainment. This research is significant because a) India is ranked 109 among 167 countries regarding SDG attainment. Progress in most SDGs remains a matter of concern, and b) the SDGs do not specifically target caste-based discrimination.

PMID:39724676 | DOI:10.1016/j.jenvman.2024.123850

Liver Transpl. 2024 Oct 14. doi: 10.1097/LVT.0000000000000508. Online ahead of print.

ABSTRACT

Posttransplant diabetes mellitus (PTDM) is associated with significant morbidity and mortality in liver transplant recipients (LTRs). We used the Organ Procurement and Transplantation Network (OPTN) database to compare the incidence of developing PTDM across the United States and develop a risk prediction model for new-onset PTDM using OPTN region as well as donor-related, recipient-related, and transplant-related factors. All US adult, primary, deceased donor, LTRs between January 1, 2007, and December 31, 2016, with no prior history of diabetes noted, were identified. Kaplan-Meier estimators were used to calculate the cumulative incidence of PTDM, stratified by OPTN region. Multivariable Cox proportional hazards models were fitted to estimate hazards of PTDM in each OPTN region and build a risk prediction model, through backward selection. Cumulative incidence of PTDM at 1 year, 3 years, and 5 years after transplant was 12.0%, 16.1%, and 18.9%, respectively. Region 3, followed by regions 8, 2, and 9, had the highest adjusted hazards of developing PTDM. Inclusion of OPTN region in a risk prediction model for PTDM in LTRs (including recipient age, sex, race, education, insurance coverage, body mass index, primary liver disease, cold ischemia time, and donor history of diabetes) modestly improved performance (C-statistic = 0.60). In patients without pre-existing, confirmed diabetes mellitus, the incidence of PTDM in LTRs varied across OPTN regions, with the highest hazards in region 3, followed by regions 8, 2, and 9. The performance of a novel risk prediction model for PTDM in LTRs has improved performance with the inclusion of the OPTN region. Vigilance is recommended to centers in high-risk regions to identify PTDM and mitigate its development.

PMID:39724669 | DOI:10.1097/LVT.0000000000000508

J Perinat Neonatal Nurs. 2024 Oct 4. doi: 10.1097/JPN.0000000000000881. Online ahead of print.

ABSTRACT

BACKGROUND: Skin care of sick newborns is important because skin acts as a barrier to prevent neonates from infections which may lead to neonatal morbidity and mortality. The highly technological environment of the neonatal intensive care unit (NICU) makes them vulnerable to loss of skin integrity. In acute care setting maintenance of skin integrity is considered as an established quality indicator representing nursing care.

AIM OF STUDY: The study aimed to determine the effect of skin care guidelines on nurses’ knowledge related to skincare and the incidence of skin injuries among neonates.

METHODOLOGY: Pre-post quasi-experimental study was conducted in the NICU of a private tertiary care hospital. A consecutive sampling technique was used. The intervention comprised educational sessions and demonstrations of skin care practices from AWHONN skin care guidelines. The data on the nurses’ knowledge were collected through self-developed and self-administered questionnaires. Skin injuries were recorded on a checklist through observation for 1 month before and after the intervention. A paired sample t-test was used for comparing knowledge and continuous demographical variables. While the incidence density ratio was calculated for skin injuries.

RESULTS: There was a statistically significant improvement in the nurses’ knowledge of skin care from pre (mean 15.06 ± 5.16) to post (mean19.40 ± 5.17) measurement P-value .001. Incidence density rate of skin injuries reduced from 19% to 3% after the implementation of skin care guidelines.

CONCLUSION: Through the implementation guidelines nurses’ knowledge and practices regarding skin care improved while skin injuries among neonates were reduced.

PMID:39724665 | DOI:10.1097/JPN.0000000000000881

J Craniofac Surg. 2024 Oct 7. doi: 10.1097/SCS.0000000000010735. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to investigate psychiatric sequelae in open globe injury patients and to identify the risk factors associated with these sequelae.

METHODS: After a complete ophthalmologic examination, Davidson Trauma Scale (DTS), State-Trait Anxiety Inventory (STAI), and Zung Depression Scale (ZDS) scores were administered to all patients. Patients were divided into 5 groups according to final best corrected visual acuity (BCVA): group 1 (no perception of light, NPL), group 2 [perception of light (PL) or hand movements (HM)], group 3 (1/200 to 19/200), group 4 (20/200 to 20/50), and group 5 (20/40 or above).

RESULTS: A total of 113 patients with open globe injuries were included. The mean ZDS scores were 78.5±35.9 in group 1, 66.2±24.5 in group 2, and 27.6±2.1 in group 5. In group 1, 8 patients (66.7%) had moderate depression. In group 2, 20 patients (60.6%) had mild depression. All patients in group 4 and group 5 had ZDS scores in the normal range. There is a statistically significant difference between the groups in terms of ZDS scores. In univariate analysis, depression (ZDS) and trauma (DTS) scores were associated with younger age (P=0.016 and P=0.003, respectively) and lower final visual acuity level (P<0.001, for both). In multivariate analysis adjusted for age and sex, a lower final visual acuity level (P<0.001, for both) was also associated.

CONCLUSIONS: In conclusion, high anxiety and depression scores can be seen in open globe injury patients. Patients with young age and lower final visual acuity should be carefully screened, and the presence of a psychiatric pathology should be investigated. Amelioration of psychiatric pathologies may improve patient compliance with treatment and clinical success.

PMID:39724643 | DOI:10.1097/SCS.0000000000010735