Tag: pubmed

J Hosp Infect. 2024 Oct 25:S0195-6701(24)00356-6. doi: 10.1016/j.jhin.2024.10.008. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to evaluate whether subcutaneous tunneling in peripherally inserted central catheters (PICC) placement could reduce the occurrence of central-line associated blood stream infection (CLABSI).

METHODS: We conducted an open-label, multicentre, randomized, controlled trial in five tertiary hospitals. Adult hospitalized patients requiring a PICC were randomized in a one-to-one ratio to conventional (cPICC) or tunneled PICC (tPICC) arms using a centralized web-based computer-generated stratified randomization. CLABSI rates between groups were compared in a modified intention-to-treat population. Safety including the incidence of exit-site infection or hemorrhage-associated catheter removal were also compared. This trial was registered with Clinical Research Information Service of Republic of Korea (KCT0005521).

RESULTS: From November 2020 to March 2023, 1,324 participants were enrolled and randomly assigned to tPICC (n=662) and cPICC (n=662). This study was terminated early due to the cohort CLABSI rate being lower than estimated, therefore, the original sample size of 1,694 would render the study underpowered to detect a difference in CLABSI rates. In the tPICC, CLABSI occurred in 13 of 651 participants over 11,071 catheter-days (1.2/1,000 catheter-days), compared with 20 among 650 patients with cPICC over 11,141 catheter-days (1.8/1,000 catheter-days, rate ratio 0.65, 95% CI 0.30-1.38, p=0.30). The incidence of exit-site infection (29 tPICC, 36 cPICC, p=0.5) and hemorrhage-associated catheter removal (11 tPICC, 11 cPICC, p=0.99) was not different between both groups.

CONCLUSION: Due to insufficient sample size, this study could not demonstrate a statistically significant CLABSI risk reduction in the tPICC group compared to the cPICC group. Both groups had similar rates of exit site infection and bleeding.

PMID:39490586 | DOI:10.1016/j.jhin.2024.10.008

World Neurosurg. 2024 Oct 25:S1878-8750(24)01781-9. doi: 10.1016/j.wneu.2024.10.077. Online ahead of print.

ABSTRACT

BACKGROUND: This study explores the vital elements of patient satisfaction in hospital settings, with an emphasis on the aspects of service quality and patient-hospital interaction. It looks at how patients perceive several aspects of service quality, such as assurance, tangibility, empathy, responsiveness, and consistency.

METHODOLOGY: A descriptive cross-sectional study was conducted among 80 Neurosurgery in-patients at the Pakistan Institute of Medical Sciences (PIMS), using convenience sampling. Data collection was done after obtaining consent from each patient. A self-administered questionnaire was used to collect demographic data, and patient satisfaction with the outpatient clinic experience. Data were entered and analyzed in Statistical Package for the Social Sciences, version 25. A chi-square test was used to examine associations between outcome variables and factors related to patient satisfaction.

RESULTS: The majority of the patients were males, 46 (57.5%). The mean age of the patients was 48.73 ± 18.428 years. The waiting time at the hospital also varies, with 77.5% of patients experiencing 0-hour wait time, and the mean waiting time being 38.44 minutes. A positive correlation was found between the following variables: travel time in minutes (χ2 = 0.012, p > 0.05) ; gender (χ2 = 0.037, p < 0.05) ; and the number of hospital visits per month (χ2 = 0.016, p > 0.05) and patient interaction in a health care setting.

CONCLUSION: The study emphasizes the value of excellent patient-hospital interactions and the importance of communication, empathy, and trust-building in promoting these outcomes.

PMID:39490577 | DOI:10.1016/j.wneu.2024.10.077

J Am Coll Radiol. 2024 Oct 26:S1546-1440(24)00852-4. doi: 10.1016/j.jacr.2024.10.011. Online ahead of print.

ABSTRACT

PURPOSE: Routine imaging of soft tissue infection is not recommended and represents a potential area of computed tomography (CT) overuse. The utility of CT in patients with superficial soft tissue infection of the extremities is unknown. The purpose of this study is to evaluate the utilization and clinical impact of CT ordered in the setting of extremity cellulitis.

METHODS: We retrospectively analyzed patients with extremity cellulitis examined with CT between 2012-2021 at a single center. We collected patient history, diagnostic imaging characteristics, and subsequent surgery decision. We hypothesized that yield of CT for deep infection was significantly lower than 10% and that yield was decreasing over time. These hypotheses were evaluated with Rao-Scott Chi-Square tests and repeated measures logistic regression.

RESULTS: There were 496 eligible encounters among 463 patients. Yield of positive CT among lower extremity patients was 5.5% (95%CI 3.33-7.75), significantly less than our hypothesis of 10% (p=0.003). In 71.8% of encounters, patients underwent diagnostic imaging studies in addition to CT. Utilization rose from 0.08% per hospital visit in 2012-2013 to 0.14% in 2020-2021, with differences in yield between time periods not reaching statistical significance (p=0.059). Among 496 encounters, 62 received surgery (12.1%), with 21 of these cases preceded by a positive CT for deep infection.

CONCLUSIONS: Our 10-year single-center analysis of CT use for extremity cellulitis demonstrated a low yield of positive CT findings for deep infection and limited impact of CT on surgical management. A high incidence of patients undergoing multiple radiologic exams suggests uncertainty in selecting appropriate imaging modalities in this clinical scenario.

PMID:39490568 | DOI:10.1016/j.jacr.2024.10.011

Updates Surg. 2024 Nov 3. doi: 10.1007/s13304-024-02000-4. Online ahead of print.

ABSTRACT

Adenocarcinomas, a common subtype of lung cancer, exhibit diverse histological patterns. In 2020, The International Association for the Study of Lung Cancer (IASLC) introduced a grading system emphasizing high-grade components, which has shown prognostic value. Spread through air spaces (STAS) is recognized as a prognostic feature increasing the risk of recurrence in lung cancer. This study evaluates the combination of STAS status and the IASLC-grading system in surgically resected Stage I lung adenocarcinomas. This study is a retrospective analysis of 123 patients with Stage I lung adenocarcinoma who underwent lobectomy between 2011 and 2019. Histological patterns were assessed according to the IASLC criteria, and STAS status was documented. Patients were categorized based on their IASLC Grade and STAS status. Statistical analyses included Kaplan-Meier survival estimates, Cox proportional hazards models, and comparisons using Chi-square and t-tests. The cohort comprised 43 females and 80 males with a mean age of 61.8 ± 7.6 years. STAS positivity was noted in 52.8% of patients. STAS positivity correlated significantly with Grade 3 tumors (p < 0.001). The 5-year recurrence-free survival was significantly lower in STAS-positive patients (70.7% vs. 88.7%, p = 0.026). Patients with Grade 3 and STAS positivity had significantly lower recurrence-free survival compared to other groups (p = 0.002). Grade 3 and STAS positivity were independent predictors of poor recurrence-free survival in multivariate analysis. IASLC Grade 3 tumors and STAS positivity are independent prognostic factors for poor recurrence-free survival in Stage I lung adenocarcinomas. Adjuvant treatment strategies should be considered for patients with these characteristics to improve outcomes.

PMID:39488820 | DOI:10.1007/s13304-024-02000-4

Tissue Eng Regen Med. 2024 Nov 3. doi: 10.1007/s13770-024-00671-z. Online ahead of print.

ABSTRACT

BACKGROUND: Periodontitis is a severe chronic inflammatory disease, whose traditional systemic antimicrobial therapy faces great limitations. In-situ gels provide an effective solution as an emerging local drug delivery system.

METHODS: In this study, the novel thermosensitive poloxamer/carbopol in-situ gels loaded with 20 μmol/L quercetin for the treatment of periodontitis were prepared by cold method. Thirteen batches of in-situ gels based on two independent factors (X₁: poloxamer 407 and X₂: carbopol 934P) were designed and optimized by the statistical method of central composite design (CCD). The transparency, pH, injectability, viscosity, gelation temperature, gelation time, elasticity modulus, degradation rate and in-vitro drug release studies of the batches were evaluated, and the percentage of drug release in the first hour, the time required for 90% drug release, gelation temperature, and gelation time were selected as dependent variables.

RESULTS: These two independent factors significantly affected the four dependent variables (p < 0.05). The optimization result displayed that the optimized concentration of poloxamer 407 was 20.84% (w/v), and carbopol 934P was 0.5% (w/v). The optimized formulation showed a clear appearance (++), acceptable injectability (Pass), viscosity(151,798 mPa s), gelation temperature (36 °C), gelation time (213 s), preferable cell viability and cell proliferation, conformed to first-order release kinetics, and had a significant antibacterial effect.

CONCLUSIONS: The article demonstrates the great potential of the quercetin in-situ gel as an effective treatment for periodontitis.

PMID:39488811 | DOI:10.1007/s13770-024-00671-z

Neuromodulation. 2024 Nov 2:S1094-7159(24)00707-4. doi: 10.1016/j.neurom.2024.09.002. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to investigate the analgesic effects of H-coil repetitive transcranial magnetic stimulation (rTMS) primarily targeting the hand area of the primary motor cortex (M1) in patients with peripheral neuropathic pain. Given that the H-coil has a wider reach than conventional coils, there is a possibility that targeting the hand motor cortex also may stimulate prefrontal areas. Thus, we also aimed to examine whether rTMS with an M1 target could produce effects on psychologic outcomes.

MATERIALS AND METHODS: In total, 17 patients were randomly assigned to receive active or sham H-coil rTMS in a counterbalanced order. After a nine-week washout period, they crossed over to either active or sham rTMS, according to a double-blind crossover design. Each treatment period consisted of five daily rTMS sessions and a one- and three-week follow-up visit. The primary outcome was average usual pain intensity. Secondary outcomes included pain unpleasantness, dynamic and static mechanical allodynia, anxiety and depression, sleep, pain catastrophizing, function, and patients’ impression of change. Effects of rTMS were investigated using linear mixed model analyses.

RESULTS: We found two significant interactions between treatment and time, indicating that active H-coil rTMS induced significant analgesic effects (t [134] = -2.18; p = .03; d = -0.10) and significant reductions in anxiety and depression compared with sham stimulation over the treatment course (t [73] = -2.14; p = .04; d = -0.09). The analgesic effect occurred two weeks after the treatment, and the effect on anxiety and depression occurred three weeks after treatment. No other significant interactions were found for the secondary variables.

CONCLUSIONS: Five days of H-coil rTMS targeting the hand area of M1 induced statistically significant effects on pain intensity. Moreover, rTMS improved symptoms of anxiety and depression, possibly because of the wide and deep reach of the H-coil.

CLINICAL TRIAL REGISTRATION: The Clinicaltrials.gov registration number for the study is NCT05488808.

PMID:39488777 | DOI:10.1016/j.neurom.2024.09.002

J Inj Violence Res. 2024 Nov 3;16(2). doi: 10.5249/jivr.v16i2.1842. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to investigate the effects of CPT on PTSD, depression, and anxiety symptoms in female victims of domestic violence.

METHODS: A two-arm randomized clinical trial was conducted in Bandar-Abbas involving 62 female victims of domestic violence referred from private gynecology and obstetrics clinics. Initial screening for domestic violence was based on the World Health Organization violence questionnaire. Participants were randomly assigned to either a control group (n=32) or an intervention group (n=28) for a study duration of six months in 2022. Twelve group CPT sessions were conducted. The domestic violence questionnaire, Beck’s Depression Inventory, Beck’s Anxiety Inventory, and the Impact of Event Scale-Revised were completed in three time points: pre-test, post-test, and follow-up.

RESULTS: There was a statistically significant difference in the mean scores of depression, PTSD, and domestic violence (P less than .001) between the two groups; however, no significant difference was found in anxiety scores (P greater than .050).

CONCLUSIONS: CPT is recommended for female victims of domestic violence to reduce symptoms of depression, PTSD, and domestic violence.

PMID:39488744 | DOI:10.5249/jivr.v16i2.1842

Chirurgia (Bucur). 2024 Oct;119(eCollection):1. doi: 10.21614/chirurgia.119.eC.3032.

ABSTRACT

OBJECTIVE: To compare the accuracy of arthroscopy with MRI in diagnosing ramp lesions associated with anterior cruciate ligament (ACL) injuries.

DESIGN: Prospective observational study. Material and Methods: We included 100 patients with complete ACL tear.

EXCLUSION CRITERIA: 1) Partial ACL tear, 2) ACL revision surgery or previous knee surgery, 3) Multi-ligamentous knee injury, 4) Extensive medial meniscus tear. Results: Nine patients were diagnosed with ACL-associated ramp lesions. All nine had magnetic resonance imaging (MRI) signs, but these were not statistically significant ( 2=1.884, FEp=0.348). Mean medial meniscal slope for patients with ramp lesions was 2.88 +- 0.46, without was 2.47 +- 0.55 (T=2.146, P=0.034), implying statistical significance as visualized by arthroscopy. Arthroscopy is superior in diagnosing ramp lesions.

CONCLUSION: Arthroscopy is superior in diagnosing ramp lesions due to cost-effectiveness, direct visualization, and immediate treatment capability. The absence of specific MRI signs for ramp lesions further supports this conclusion.

PMID:39488742 | DOI:10.21614/chirurgia.119.eC.3032

Cancer. 2024 Nov 2. doi: 10.1002/cncr.35608. Online ahead of print.

ABSTRACT

The study of prehabilitation and rehabilitation ([p]rehabilitation) to alleviate the sequelae of bladder cancer and its treatment has generated numerous opportunities to improve the quality of life of bladder cancer survivors. The authors conducted a scoping review of randomized clinical trials (RCTs) to identify knowledge gaps in and research directions for (p)rehabilitative support for those affected by bladder cancer. The authors systematically searched six databases and synthesized key findings from RCTs conducted from January 1, 2004, through March 15, 2022, that enrolled participants with bladder cancer, survivors, or caregivers in outpatient (p)rehabilitative programs (e.g., exercise, nutrition, or psychological support). Outcomes were characterized according to eight prespecified, clinically relevant categories. The search retrieved 10,968 records, 27 of which met the inclusion criteria, and 24 described unique RCTs with 2471 enrolled participants. Of 24 interventions, 17 (71%) yielded statistically significant results for the outcome of interest. Only one RCT included a cost-effectiveness analysis, and only two characterized the efficacy of interventions for caregivers. Of 11 RCTs involving psychological support, eight yielded statistically significant results, as did nine of 11 RCTs with physical exercise interventions, three of four RCTs with educational interventions, three of four RCTs with nutritional support interventions, one of two RCTs with pharmacologic medications, and zero of one RCT with physical therapy. The most promising interventions for inclusion in multimodal, personalized (p)rehabilitation programs included exercise, stress management training, cognitive training, smoking and alcohol cessation counseling, immunonutrition, stoma education, and penile rehabilitation. Further studies of the cost effectiveness and efficacy for caregivers of such interventions are needed. PLAIN LANGUAGE SUMMARY: In a scoping review of all randomized clinical trials involving prehabilitative or rehabilitative diet, exercise, and psychological support interventions for patients with bladder cancer, survivors, and their caregivers, 17 of 24 (71%) interventions yielded statistically significant improvements in the outcome of interest. Clinicians should consider implementing such interventions for those affected by bladder cancer.

PMID:39488730 | DOI:10.1002/cncr.35608

Sr Care Pharm. 2024 Nov 1;39(11):425-431. doi: 10.4140/TCP.n.2024.425.

ABSTRACT

Background: Additional evidence is required to address the unintended consequences of medication use in older people and the required caregiver support. To inform priorities for future research efforts, different stakeholder perspectives are needed, including those of older people, caregivers, clinicians, and researchers. Objective: To develop a co-designed medication-related research agenda. Methods: A 12-member Advisory Council, half of which were older people and caregivers, designed the research. An 11-question survey to identify priorities for medication-related patient-centered outcomes research (PCOR) topics was administered to members of the Elder Care Medicine Network (ECMN) (ie, older people, caregivers, clinicians, and researchers). Respondents were categorized into two groups with hierarchical assignment to the clinician/research group over the older adult/caregiver group. Chi-square tests compared priority areas for medication-related PCOR between the two groups. Results: There were 53 responses (48% response rate) from the ECMN, with 39.6% (n = 21) from the clinician/researcher group and 60.4% (n = 32) from the older adult/caregiver group. The priority areas from both groups included safe ways to simplify medicines (62.2%), communicating with pharmacists and prescribers about medications (58.5%), and information about safe supplements with prescription medications (52.8%). Statistically significant differences existed between the two groups in the proportions choosing the priority areas. Conclusion: Co-design of a survey to identify priority areas for PCOR demonstrated successful engagement of older people and caregivers as research partners. While older people and caregivers may have differing perspectives on the importance of specific medication-related PCOR topics, simplifying medication regimen and health care communications were germane to both groups.

PMID:39488722 | DOI:10.4140/TCP.n.2024.425