Tag: pubmed

Cureus. 2024 Dec 22;16(12):e76179. doi: 10.7759/cureus.76179. eCollection 2024 Dec.

ABSTRACT

Background and objectives A modified aligner appliance with nickel-titanium springs (MAA) is a relatively new appliance that has not received extensive attention in orthodontics. This study evaluated the patient-reported outcomes when orthodontic treatment was provided using a modified aligner appliance to treat mild lower incisor crowding. Materials and methods This prospective cohort study consisted of 42 patients (11 males and 31 females; mean age 21.69 ± 2.56 years) with mild crowding. Twenty-one patients were treated using a modified aligner with nickel-titanium springs, while the remaining patients were treated with a conventional fixed orthodontic appliance (FA). Patient responses regarding pain, discomfort, and difficulty in chewing, swallowing, and speaking were recorded using a visual analog scale (VAS) at six assessment times: 24 hours (T1), two days (T2), three days (T3), two weeks (T4), one month (T5), and two months (T6) after appliance application. Results The mean perceived pain and discomfort levels were generally lower in the traditional fixed appliance (FA) group than the modified aligner appliance with nickel-titanium springs group at most assessment times. However, no statistically significant differences were found between the two groups. Chewing difficulty levels were similar between the two groups with no substantial differences. Swallowing and speech difficulty were significantly higher in the MAA group compared to the FA group during the first two days of treatment (P < 0.008). Conclusions Patients using both types of orthodontic appliances experienced temporary discomfort, including pain and difficulty chewing. While the modified aligners appliance with nickel-titanium springs caused additional challenges with swallowing and speaking, these issues were resolved over time, allowing patients to adjust to the treatment.

PMID:39711937 | PMC:PMC11663397 | DOI:10.7759/cureus.76179

GMS J Med Educ. 2024 Nov 15;41(5):Doc52. doi: 10.3205/zma001707. eCollection 2024.

ABSTRACT

AIMS: Comprehensive provision of general healthcare (i.e. primary care) within the populace is contingent on there being enough general practitioners (GPs) in proximity to patients. It is no longer the case that vacated allocated positions for primary-care physicians are being filled in all regions. Support for specialist training in general medical practice is one of the measures intended to ensure provision of GP services. This analytical project aims to make a data-driven contribution to gauging the impact of such support on primary care in Germany, while also delivering pointers for further research.

METHODS: On the basis of routinely collected data, the history of such support was examined in detail for all practice-based, statutory health insurance (SHI)-accredited GPs during the period 2016-2022. In the analysis, GPs were broken down by whether they took up full-time or part-time roles, self-employed or salaried roles, and roles in a practice or in an ambulatory healthcare centre (MVZ).

RESULTS: During the period under review, the proportion of those who have both recently commenced work as SHI-accredited GPs and had previously used support for their specialist training, increased from 57% to 81%. The total number of new GPs (headcount) rose from 1,590 to 1,955. Results indicate that those who had availed themselves of this support take up self-employed and full-time roles more often than those who had not.

CONCLUSIONS: Both take-up of support for specialist training, and the number of new GPs, increased markedly during the period under review. The data does not indicate any causal links. However, these results could form a jumping-off point for further research (in general) into support for specialist training, and (in particular) into how this may impact these individuals’ subsequent work roles.

PMID:39711872 | PMC:PMC11656181 | DOI:10.3205/zma001707

GMS J Med Educ. 2024 Nov 15;41(5):Doc54. doi: 10.3205/zma001709. eCollection 2024.

ABSTRACT

BACKGROUND: A competency-based education approach calls for frequent workplace-based assessments (WBA) of Entrustable Professional Activities (EPAs). While mobile applications increase the efficiency, it is not known how many assessments are required for reliable ratings and whether the concept can be implemented in all sizes of residency programs.

METHODS: Over 5 months, a mobile app was used to assess 10 different EPAs in daily clinical routine in Swiss anesthesia departments. The data from large residency programs was compared to those from smaller ones. We applied generalizability theory and decision studies to estimate the minimum number of assessments needed for reliable assessments.

RESULTS: From 28 residency programs, we included 3936 assessments by 306 supervisors for 295 residents. The median number of assessments per trainee was 8, with a median of 4 different EPAs assessed by 3 different supervisors. We found no statistically significant differences between large and small programs in the number of assessments per trainee, per supervisor, per EPA, the agreement between supervisors and trainees, and the number of feedback processes stimulated. The average “level of supervision” (LoS, scale from 1 to 5) recorded in larger programs was 3.2 (SD 0.5) compared to 2.7 (SD 0.4) (p<0.05). To achieve a g-coefficient >0.7, at least a random set of 3 different EPAs needed to be assessed, with each EPA rated at least 4 times by 4 different supervisors, resulting in a total of 12 assessments.

CONCLUSION: Frequent WBAs of EPAs were feasible in large and small residency programs. We found no significant differences in the number of assessments performed. The minimum number of assessments required for a g-coefficient >0.7 was attainable in large and small residency programs.

PMID:39711857 | PMC:PMC11656171 | DOI:10.3205/zma001709

SAGE Open Nurs. 2024 Dec 19;10:23779608241305782. doi: 10.1177/23779608241305782. eCollection 2024 Jan-Dec.

ABSTRACT

INTRODUCTION: The intrauterine device (IUD) represents the most cost-effective, long-acting reversible form of contraception, but accounts for only 1% of all contraception methods used in Tanzania.

OBJECTIVE: This study aims to determine the uptake of IUD use and investigate the perceptions, challenges, and recommendations surrounding the use of intrauterine devices among women of reproductive age in Tanzania.

METHOD: A cross-sectional study was conducted including 347 women, as well as qualitative semi-structured interviews with 11 women. Quantitative data were entered into SPSS, and descriptive statistics were employed to summarize the data. Content analysis was used to analyse the qualitative data.

RESULTS: The prevalence of IUD use was 5%. The majority of the women interviewed were aware of myths and misconceptions concerning IUDs but wanted to use it after receiving information from healthcare providers.

CONCLUSION: The study found that the use of intrauterine devices was low in the study area and that there is a need to strengthen community engagement to reduce misconceptions about the use of IUDs.

PMID:39711855 | PMC:PMC11660266 | DOI:10.1177/23779608241305782

SAGE Open Nurs. 2024 Dec 19;10:23779608241307447. doi: 10.1177/23779608241307447. eCollection 2024 Jan-Dec.

ABSTRACT

BACKGROUND: Continuous Professional Development (CPD) programs are crucial for enhancing the quality of healthcare delivery. The presence of incompetent and unskilled healthcare professionals is not satisfactory. This study aimed to evaluate nurses’ engagement in CPD programs and identify the barriers affecting this engagement.

METHODS: A mixed-methods approach, combining quantitative and qualitative cross-sectional studies, was employed from April 1 to 30, 2022. The quantitative component involved 271 randomly selected nurses, while nine key informants were purposively chosen for qualitative analysis. Data were collected using a structured self-administered questionnaire with a content validity index of 0.91 and an interview guide. Ethical guidelines were strictly followed. Quantitative data were entered into Epi-data version 3.1 and analyzed with SPSS version 25.0. Descriptive statistics described participant characteristics, while chi-square tests and logistic regression analyses assessed the relationships between independent and outcome variables, with significance set at p < 0.05 and goodness-of-fit evaluated by the Hosmer-Lemeshow test (>0.05). Qualitative data were analyzed using manual exploratory descriptive methods and thematic analysis.

RESULTS: Of the 271 nurses, 262 (96.7%) participated, with a median age of 28 years. The overall CPD engagement rate was 34.4%. Factors influencing CPD engagement included financial constraints (adjusted odds ratio [AOR] = 3.1, 95% CI: 1.28-7.52), lack of access to CPD information (AOR = 0.3, 95% CI: 0.12-0.76), time constraints due to family commitments (AOR = 3.35, 95% CI: 1.08-10.34), and insufficient CPD resources (AOR = 0.15, 95% CI: 0.03-0.742). Qualitative findings revealed low CPD engagement levels, insufficient financial support, reluctance to self-finance training, the positive impact of diverse training mediums, and barriers related to nurses’ attitudes and the availability of training.

CONCLUSION: Nurses’ engagement in CPD is notably low. Financial and time constraints, along with limited access to information and resources, significantly hinder participation in CPD activities.

PMID:39711853 | PMC:PMC11660062 | DOI:10.1177/23779608241307447

SAGE Open Nurs. 2024 Dec 20;10:23779608241302098. doi: 10.1177/23779608241302098. eCollection 2024 Jan-Dec.

ABSTRACT

INTRODUCTION: The World Health Organization emphasizes that neonatal resuscitation performed in the first “golden minute” following birth can influence both immediate and long-term outcomes of newborns, especially asphyxiated ones. The modes of resuscitation, which is an evidenced-based practice, require evaluation to identify their effectiveness.

OBJECTIVES: This study evaluated neonatal resuscitation techniques and their effectiveness in the management of asphyxiated neonates during the perinatal period.

DESIGN: Cross-sectional design with observation of delivery and immediate care of 254 newborns in five hospitals from April to June 2022.

METHODS: Neonatal resuscitation and demographic characteristics were noted. Data were analyzed descriptively using STATA 17 and Cramer’s V test of association between APGAR scores and resuscitation modes was done with statistical significance established at p ≤ .05.

RESULTS: Neonatal resuscitation was primarily performed by midwives (98.4%), with 48.8% of the infants resuscitated after birth. The most common modalities of resuscitation were drying, keeping warm, rubbing the back, and flicking the feet, with 46.0% started on bag and mask ventilation. The success rate of resuscitation was impressive (58.1%), satisfactory (38.7%), and poor (3.2%). There was a strong association of the first minute APGAR score with drying the neonate (p = .0001, φc = 0.619), keeping the neonate warm, and rubbing the back of the neonate (p = .0001, φc = 0.613). However, their association with the fifth minute APGAR score was weak (p = .002, φc = 0.222). Feet flicking has no significant association with the fifth minute APGAR score.

CONCLUSION: Neonatal resuscitation, which is an evidence-based practice, is more effective in the first minute than in the fifth minute. Regular training of midwives to update their resuscitation skills is important to promote timely and efficient resuscitation of newborns. Further studies into the advancements in resuscitation modes and the use of technology to improve resuscitation beyond the first minute are recommended.

PMID:39711852 | PMC:PMC11660072 | DOI:10.1177/23779608241302098

Front Vet Sci. 2024 Dec 6;11:1453196. doi: 10.3389/fvets.2024.1453196. eCollection 2024.

ABSTRACT

Meat rabbits are a small herbivorous livestock and have been popularly raised in China for producing high-quality meat. Therefore, it is economically important to genetically improve both carcass performance and meat quality in meat rabbits. However, we still know less about the underlying candidate genes that may determine phenotypic variation on carcass and meat traits of meat rabbits. The main objective of this study was to identify candidate genes whose mRNA expression levels may be significantly involved in regulating carcass and meat traits of meat rabbits based on the transcriptome-wide association studies (TWAS). Five carcass traits of the carcass weight (CW), dressing out percentage (DP), cut weight of hind legs (LW), weight ratio of cut hind legs to carcass (RLW), and weight of visceral and interscapular fat (WF), as well as two meat traits of the drip loss (DL) and cooking loss (CL) were phenotyped in a F1 crossbred population (N = 119) between Zika rabbits and Sichuan White rabbits. The effects of mRNA expression levels of a total of 10,288 genome-wide genes on these seven traits were statistically estimated using the mixed linear model, in which the polygenic background effects were accounted for. Our results revealed two candidate genes (RDH5 and MTARC2) that were statistically significantly associated with LW trait (the adjusted p values <0.05), whereas no gene reached the statistically significant threshold for all the remaining six traits. Because of the relatively small sample size analyzed, we alternatively selected 20 candidate genes with the lowest p values for every trait and subjected them to functional enrichment analyses, which identified three Gene Ontology (GO) terms that were significantly enriched by the candidate genes of CW and RLW traits. In conclusion, this study used TWAS approach to successfully reveal several candidate genes whose mRNA expression levels may be involved in regulating carcass and meat traits in meat rabbits, which are helpful to explore the underlying molecular mechanism in the future studies.

PMID:39711797 | PMC:PMC11660804 | DOI:10.3389/fvets.2024.1453196

Front Neurol. 2024 Dec 6;15:1503975. doi: 10.3389/fneur.2024.1503975. eCollection 2024.

ABSTRACT

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by inattention, impulsivity, and hyperactivity. With the continuous development of neuromodulation technology, Repetitive Transcranial Magnetic Stimulation (rTMS) has emerged as a potential non-invasive treatment for ADHD. However, there is a lack of research on the mechanism of rTMS for ADHD. Functional near infrared spectroscopy (fNIRS) is an optical imaging technique that reflects the brain function by measuring changes in blood oxygen concentration in brain tissue. Consequently, this research utilized fNIRS to examine the impact of rTMS on the core symptoms and prefrontal cortex activation in children with ADHD, which provides a reference for the clinical application of rTMS in the treatment of ADHD.

METHODS: Forty children with ADHD were chosen as research subjects and randomly assigned to two groups: a treatment group (20 subjects) and a control group (20 subjects). The control group received non-pharmacological interventions, whereas the treatment group was administered rTMS in conjunction with non-pharmacological interventions. Clinical symptom improvement was evaluated using SNAP-IV scale scores both before and after treatment. Additionally, fNIRS was utilized to monitor alterations in the relative concentrations of oxyhemoglobin (HbO₂) and deoxyhemoglobin (HbR) in the prefrontal cortex during resting state and during the Go/no-go task state, both pre- and post-treatment.

RESULTS: In conclusion, the study comprised 17 participants in the treatment group and 18 in the control group. Initially, the SNAP-scale scores were comparable between the groups, with no significant differences observed (p > 0.05). Post-treatment, a notable reduction in SNAP-scale scores was evident (p < 0.05), with the treatment group exhibiting a more pronounced decrease (p < 0.05). Following the intervention, both groups demonstrated enhanced Resting-state functional connectivity (RSFC) in the prefrontal cortex, as indicated by a significant increase compared to pre-treatment levels (p < 0.05). Specifically, the treatment group showed superior RSFC in the left dorsolateral prefrontal cortex, right dorsolateral prefrontal cortex, left medial prefrontal cortex, and right medial prefrontal cortex compared to the control group (p < 0.05). However, no significant differences were noted in RSFC of the left and right temporal lobes between the two groups (p > 0.05). In the Go/no-go task, the treatment group recorded higher mean HbO₂ concentrations in the aforementioned prefrontal cortical regions compared to the control group (p < 0.05). Conversely, no statistically significant disparities were observed in the left and right temporal lobes of both groups.

CONCLUSION: rTMS shows promise as a treatment for ADHD by modulating prefrontal cortical activation. fNIRS provides a valuable method for assessing these effects, offering insights into the neurobiological mechanisms underlying rTMS therapy.

PMID:39711791 | PMC:PMC11659132 | DOI:10.3389/fneur.2024.1503975

Front Neurol. 2024 Dec 6;15:1479476. doi: 10.3389/fneur.2024.1479476. eCollection 2024.

ABSTRACT

BACKGROUND: Relapsing multiple sclerosis (RMS) is a chronic, inflammatory disease of the central nervous system. Ublituximab, an anti-CD20 monoclonal antibody (mAb), is indicated for the treatment of RMS. We performed a systematic literature review (SLR) to identify randomized trials reporting the clinical efficacy and tolerability of ublituximab or comparator disease-modifying therapies (DMTs) for treatment of RMS, and assessed their comparative effects using network meta-analysis (NMA).

METHODS: The SLR involved a comprehensive search across various medical databases to identify relevant studies. Included studies were randomized controlled trials (RCTs) of an adult RMS population, focusing on treatment with at least one of ublituximab, alemtuzumab, natalizumab, ocrelizumab, or ofatumumab. For outcomes included in the NMA (annualized relapse rate (ARR), confirmed disability progression (CDP), and treatment discontinuation rate), rate ratios (RR) or hazard ratios (HR), along with their 95% confidence intervals (CIs), were calculated. We performed NMA using a contrast-based random-effects model within a frequentist framework for all outcomes. Ranking probabilities among comparators, and intervention rankings for the NMA, were estimated using surface under the cumulative ranking curve (SUCRA).

RESULTS: We included 15 RCTs in the review. For the ARR outcome, there was no statistically significant difference between ublituximab and the other included mAbs [ofatumumab (RR 1.02 (95% CI 0.64-1.62)), natalizumab (RR 0.99 (0.59-1.65)), alemtuzumab (RR 0.86 (0.51-1.46)), and ocrelizumab (RR 0.75 (0.44-1.28))]. For CDP at 6 months, our results showed no statistically significant difference between ublituximab and the comparator mAbs [ofatumumab (HR 0.97 (0.49-1.92)), natalizumab (HR 1.13 (0.53-2.40)), alemtuzumab (HR 1.25 (0.56-2.81)), and ocrelizumab (HR 1.29 (0.57-2.90))]. For CDP at 3 and 6 months, there was no statistically significant difference between ublituximab and placebo. The all-cause treatment discontinuation rate analysis showed no significant difference between ublituximab and other mAbs, except for alemtuzumab.

CONCLUSIONS: Results of this SLR-informed NMA showed that there is no statistically significant difference between ublituximab and the other mAbs in terms of clinical efficacy. Additionally, the findings show that there is no statistically significant difference in discontinuation rates with the exception of the comparison with alemtuzumab, which may be attributed to its unique dosing schedule.

PMID:39711787 | PMC:PMC11659144 | DOI:10.3389/fneur.2024.1479476

Int J Cardiol Congenit Heart Dis. 2024 Jul 26;17:100533. doi: 10.1016/j.ijcchd.2024.100533. eCollection 2024 Sep.

ABSTRACT

BACKGROUND: The Norwood operation (NO) for infants with univentricular physiology has high interstage mortality. This study evaluated outcomes and risk factors for mortality following NO.

METHODS: Retrospective single-center study of patients undergoing NO from 2010 to 2020. Analysis used appropriate statistics.

RESULTS: Of 269 patients undergoing NO, 213 (79.2 %) survived to discharge. Non-survivors had longer bypass times, delayed sternal closure, required nitric oxide, higher vasoactive scores, required post-operative catheterization, Extracorporeal Life Support (ECLS), and longer ventilation (p < 0.05). Logistic regression showed moderate-severe atrioventricular valve regurgitation on intraoperative TEE (OR 2.6), requiring nitric oxide (OR 2.63), delayed sternal closure (OR 2.94), post-operative catheterization (OR 10.48), and ECLS (OR 14.54) increased mortality odds (p < 0.05). Multivariable analysis confirmed catheterization (aOR 10.48) and ECLS (aOR 14.54) as significant predictors. Of survivors, 26 (12.3 %) developed new morbidity, 9 (4.2 %) had unfavorable outcomes. Functional status improved from 6.0 to 8.04, mainly in feeding and respiratory domains (p < 0.0001).

CONCLUSIONS: Norwood survival was 79.2 %. Requiring post-operative catheterization and ECLS significantly increased mortality risk. Multicenter evaluation of these modifiable risk factors is needed to improve outcomes in this high-risk population.

PMID:39711779 | PMC:PMC11658261 | DOI:10.1016/j.ijcchd.2024.100533