Tag: pubmed

J Palliat Med. 2024 Oct 30. doi: 10.1089/jpm.2024.0082. Online ahead of print.

ABSTRACT

Background: Palliative care (PC) has been shown to benefit patients with metastatic cancer by managing symptoms, improving quality of life, and facilitating advance care planning. Despite this, PC is often misunderstood and underutilized. Objective: To deepen our understanding of PC barriers seen among the spine metastasis population. Design/Setting: Between March 2021 and August 2022, people with metastatic spine tumors (MSTs) at a multidisciplinary oncology clinic were administered a survey on PC prior to their scheduled appointment. These responses were compared with the Health Information National Trends Survey 5 (HINTS 5), which is a validated survey created by the National Cancer Institute between February and June of 2020. Chi-squared statistical analysis was used. Results: Fifty-six people with MST were compared with 3795 patients from the HINTS 5 database. People with MST reported a significantly higher baseline understanding of PC when compared with the general population (GP) (chi-squared = 34.4, p = <0.0001). People with MST had a higher frequency of disagreement with the statement “PC is equivalent with death” when compared with the GP (chi-squared = 12.8, p = 0.0124). Over 25% of the MST group reported no understanding of PC. Conclusion: MST patients are often referred to PC services due to the extreme symptom burden of their disease. Based on this study, in comparison to the GP, people with MST tended to have a more accurate and well-adjusted perception of the goals and functions of PC. Although reassuring, there remains a high proportion of patients who have no knowledge of PC, and groups erroneously associated PC with hospice status.

PMID:39474683 | DOI:10.1089/jpm.2024.0082

J Cachexia Sarcopenia Muscle. 2024 Oct 30. doi: 10.1002/jcsm.13614. Online ahead of print.

ABSTRACT

BACKGROUND: Although pharmacological effects of SGLT2 inhibitors on the development of frailty and sarcopenia were known, the role of SGLT1 remained less clear. The present study investigated the possible effect of SGLT1 inhibition on these conditions and explored potential mediators.

METHODS: A two-sample Mendelian randomization (MR) analysis was performed to assess the effect of SGLT1 inhibition on frailty index (FI) and low grip strength in individuals aged 60 years and older using both the FNIH and EWGSOP criteria. Subsequently, a two-step MR analysis was conducted to investigate the mediating role of insulin resistance phenotype and identify potential mediators of the effect of SGLT1 inhibition on the FI and low grip strength from 1558 plasma proteins and 1352 metabolites.

RESULTS: Genetically predicted SGLT1 inhibition was associated with decreased FI (β: -0.290 [95% CI: -0.399, -0.181]) and reduced risk of low grip strength in individuals aged 60 years and older under both FNIH (β: -0.796 [95% CI: -1.216, -0.376]) and EWGSOP criteria (β: -0.287 [95% CI: -0.532, -0.041]). The two-step MR analysis demonstrated the role of insulin resistance phenotype in mediating SGTL1 inhibition on alleviating frailty (mediation proportion = 19.56% [95% CI: 8.42%, 30.70%]). After screening, 24 proteins and 16 metabolites were identified as mediators of the impact of SGLT1 inhibition on FI. Additionally, 13 proteins and 16 metabolites were found to mediate the effect of SGLT1 inhibition on low grip strength according to FNIH criteria while 22 proteins and 6 metabolites were shown to mediate the impact of SGLT1 inhibition on low grip strength under EWGSOP criteria.

CONCLUSIONS: SGLT1 inhibition potentially mitigated frailty and sarcopenia through several biological mediators, shedding new light for therapeutic intervention.

PMID:39474649 | DOI:10.1002/jcsm.13614

J Eval Clin Pract. 2024 Oct 30. doi: 10.1111/jep.14227. Online ahead of print.

ABSTRACT

BACKGROUND: Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument have been widely used by scholars around the world to assess the methodological quality of clinical practice guidelines (CPGs). We sought to identify items or domains that are commonly scored low in the assessment, and to systematically review the issues that emerged when evaluators used the AGREE II tool for guideline quality assessment.

METHODS: A systematic search was conducted to identify articles published in medically relevant databases from 2022 to 2023 regarding the use of the AGREE II tool for the assessment of CPGs. We extracted six quality domains and overall quality assessment data of CPGs included in the literature, and processed the data using descriptive statistical analysis, difference analysis, regression analysis, and correlation analysis. A seven-point Likert scale was used to assess the reporting quality of the included articles.

RESULTS: 151 relevant publications were identified, including 2081 guidelines published between 1990 and 2022. The results of the regression analysis showed a statistically significant impact of all domains on overall guideline quality (p < 0.001; R² = 0.777). Domain 1, 2, 3, 4, and 6 scores differed significantly over time (p < 0.001) and were increasing. The score was good for Domain 4 (median 78.00 [IQR: 62.75-89.00]; mean 74.34 [SD 18.85]) and Domain 1 (median 78.00 [IQR: 61.00-90.00]; mean 73.57 [SD 21.12]). Scores were generic for Domain 6 (median 58.33 [IQR: 25.00-83.33]; mean 53.98 [SD 34.13]), Domain 2 (median 53.00 [IQR: 33.30-72.10]; mean 53.30 [SD 24.52]) and Domain 3 (median 51.00 [IQR: 26.02-73.00]; mean 50.44 [SD 27.19]). The score was poor for Domain 5 (median 36.20 [IQR: 20.20-58.32]; mean 40.21 [SD 24.90]). In addition, the quality evaluation results of the included articles showed that 33.1% were evaluated as low and 11.9% as very low.

CONCLUSIONS: AGREE II tools have facilitated the development of methodological quality for CPGs. Although the quality of CPGs has improved over time, some general low-quality problems still exist, and solving these problems will be an effective way for developers to upgrade the quality of guidelines. In addition, addressing critical issues in the evaluation of guidelines to present high-quality study reports would be another way to guide guideline development.

PMID:39474648 | DOI:10.1111/jep.14227

J Holist Nurs. 2024 Oct 30:8980101241291616. doi: 10.1177/08980101241291616. Online ahead of print.

ABSTRACT

Purpose: The study’s purpose was to assess: (1) Students’ perceptions toward mindfulness interventions, and (2) Instructors’ perceptions in implementing mindfulness interventions in their classes. Study design: Descriptive study. Methods: A total of 96 students from the second-degree option and BSN programs in the host institution participated in a mindfulness intervention prior to course activities. The four mindfulness interventions utilized in this study included: music, meditation, guided breathing, and positive affirmation. The data were analyzed using descriptive statistics on postintervention surveys. Findings: The mindfulness intervention was overwhelmingly received by the students and faculty as reflected in the result of the confidential postsurveys. The majority of the students and faculty felt that this mindfulness intervention was worth implementing in their course. Conclusion: The mindfulness intervention can promote students’ feelings of “at ease” and confidence prior to a nursing course activity.

PMID:39474643 | DOI:10.1177/08980101241291616

Environ Health (Wash). 2023 Jun 21;1(1):63-71. doi: 10.1021/envhealth.3c00051. eCollection 2023 Jul 21.

ABSTRACT

Most teenagers experience orthodontic treatment, but we do not know the possible adverse effect of the released microplastics and nanoplastics that are recently categorized as emerging contaminants. Herein, we test the rubber band that has been employed to improve the biting of teeth during the orthodontic process to confirm the release of microplastics and nanoplastics. We improve the characterization of microplastics and nanoplastics by (i) Raman imaging, to extract and map the signal from the scanning spectrum matrix or the hyperspectral matrix and to enhance the signal-to-noise ratio statistically. To effectively extract the signal, (ii) chemometrics such as principal component analysis (PCA) are explored to convert the hyperspectral matrix to an image with an increased certainty. The nonsupervised PCA is intentionally corrected, via (iii) the algebra-based algorithm, to further increase the certainty to image the microplastics and nanoplastics. Once the signal is weak, (iv) an additional algorithm of image reconstruction via deconvolution is developed to average the background noise and smooth the image. By doing so, we estimate that millions of microplastics and nanoplastics are released daily in potential from a rubber band applied in a teenager’s mouth, which might be a big concern. Overall, our approach provides a suitable option to characterize the microplastics and nanoplastics from a complex background.

PMID:39474629 | PMC:PMC11504403 | DOI:10.1021/envhealth.3c00051

Environ Health (Wash). 2023 May 30;1(1):41-52. doi: 10.1021/envhealth.3c00020. eCollection 2023 Jul 21.

ABSTRACT

A set of human milk samples, consisting of pools from up to 50 mothers that delivered their first baby was assessed for the persistent organic pollutants (POPs) listed in the Stockholm Convention. It must be noted that only samples that qualified for the criteria, as established in the global monitoring plan of the Stockholm Convention, following an initial protocol from the World Health Organization, were included. The data do not allow for an assessment of POP concentrations in breast milk with lactation period nor, in most cases and when not indicated otherwise, a comparison within the same country. The assessment does not rank the POPs as to the risk for breastfeeding. Rather the measurements provide a basis for countries to compare among POPs or with other countries. A regional preference for certain POPs could not be identified; thus, taking into account global food supply chains and local production elsewhere does not allow us to prioritize a country for a certain POP. Although the highest concentrations were always found for the sum of DDT, these samples were not prominent in multivariate statistical analyses. The best indicator for the scale of POPs in breast milk was the sampling year: the earlier a national pool was created, the higher and the wider spread were the concentrations: see the example of dioxin-like POPs and indicator PCB. For some POPs, the income of a country seems to indicate scale and POP compounds. The population density was not found to be a suitable predictor or discriminator. Since all POPs seemed to level off and some POPs were only measured after the entry-into-force of the Stockholm Convention in 2004, we do not have a strong indicator to determine POP concentrations in the 1980s or before.

PMID:39474626 | PMC:PMC11503848 | DOI:10.1021/envhealth.3c00020

Front Pharmacol. 2024 Oct 15;15:1458819. doi: 10.3389/fphar.2024.1458819. eCollection 2024.

ABSTRACT

BACKGROUND AND AIMS: Portal vein tumor thrombus (PVTT) occurs frequently in hepatocellular carcinoma (HCC) patients. However, there is currently no satisfactory treatment. Radiotherapy (RT) and tyrosine kinase inhibitors (TKI) are currently commonly used. However, whether their combined use provides a survival benefit is debatable. This retrospective study compared the efficacy and safety between radiotherapy plus lenvatinib (RT + L) and radiotherapy plus sorafenib (RT + S) in the treatment of hepatocellular carcinoma with portal vein tumor thrombus (PVTT).

METHODS: Among patients with PVTT who received RT + L or RT + S between March 2017 and September 2022, the primary endpoints were overall survival (OS) and progression-free survival (PFS). The secondary endpoints were objective response rate (ORR), disease control rate (DCR), and incidence of treatment-related adverse effects. The prognostic factors were also assessed.

RESULTS: The analysis included 152 patients (RT + L: 48; RL: 25; RT + S: 55; S: 24). Compared with the RT + S group, the RT + L group had a longer OS and PFS. Among patients with type I/II PVTT, the median OS times were 19.8 months and 13.5 months (p = 0.047) and the median PFS was 12.3 months and 7.3 months (p = 0.042), respectively. And the median OS of the patients with type I/II PVTT were 14.4 months and 8.3 months (p = 0.030) and the median PFS was 8.3 months and 6.2 months (p = 0.026). ORR and DCR in RT + L group (25.0% and 75.0%) were also little higher than those in RT + S group (20.0% and 70.9%), but not statistically significant. In univariate analysis, etiology, Type of PVTT, alpha-fetoprotein (AFP) level, Child-Pugh score, and treatment method influenced OS. Multivariate analysis confirmed that treatment method, etiology, alpha-fetoprotein (AFP) level, and Child-Pugh score were independent prognostic factors for OS. Similar safety profiles were observed in the RT + L and RT + S groups. The most common adverse events were myelosuppression, decreased liver function, fatigue, diarrhea, nausea, and vomiting. Most adverse reactions were grade 1-2.

CONCLUSION: The side effects of radiotherapy plus lenvatinib were acceptable. Compared to RT + S, RT + L had good efficacy in the treatment of hepatocellular carcinoma with PVTT. Validation is needed in prospective studies with larger sample sizes.

PMID:39474615 | PMC:PMC11518791 | DOI:10.3389/fphar.2024.1458819

Front Pharmacol. 2024 Oct 15;15:1494569. doi: 10.3389/fphar.2024.1494569. eCollection 2024.

ABSTRACT

BACKGROUND: : Increasing student numbers and logistical challenges in pharmacy education limit patient counselling and clinical placement opportunities. Computer-based simulation (CBS) offers scalable, interactive learning but faces integration barriers.

OBJECTIVE: : To explore global perceptions of CBS implementation in pharmacy education among educators and students. Methods: An online cross-sectional survey was developed based on literature review and expert feedback. The survey was distributed globally through academic pharmacy organisations, social media, and the authors’ networks. It included 20 questions targeting pharmacy educators and students.

RESULTS: : Responses from 152 educators across 38 countries and 392 students from 46 countries, spanning six WHO regions (AFRO, AMRO, EMRO, EURO, SEARO, and WPRO) were analysed using descriptive and inferential statistics. The majority of educators (90.1%, n = 137) and students (84.2%, n = 330) expressed comfort with using CBS and implementing it in their curriculum. Despite this, CBS was perceived as underutilised by 53.5% (n = 81) of educators and 63.7% (n = 250) of students. Students valued CBS for enhancing communication and problem-solving skills, while educators highlighted its relevance to community pharmacy practice. Both groups supported CBS use in assessments. All educators (100%) identified workload reduction as a key priority, hoped CBS could assist in this area. Educators also reported barriers such as financial constraints (56.6%, n = 86) and insufficient technical support (53.3%, n = 81). On the other hand, students were less optimistic about institutional support, with only a few (7.4%, n = 29) believed institutional leaders would actively support CBS adoption. Regional differences emerged, with SEARO (Southeast Asia) and AFRO (Africa) showing the lowest CBS usage rates. Educators in SEARO, AFRO, and EMRO (Eastern Mediterranean) raised concerns about technical support, while those in SEARO, AFRO, and WPRO (Western Pacific, including Australia, New Zealand, and Singapore) expressed financial concerns. Educators in AFRO and WPRO, however, reported being 100% comfortable with using CBS.

CONCLUSION: : Both students and educators recognised the potential of CBS in pharmacy education, with strong support for its integration. Addressing barriers such as educator workload, financial constraints, and technical support is crucial for broader adoption. Improved resource allocation and targeted training for educators are essential to effectively incorporate CBS into the pharmacy curriculum.

PMID:39474610 | PMC:PMC11518731 | DOI:10.3389/fphar.2024.1494569

Front Pediatr. 2024 Oct 15;12:1426588. doi: 10.3389/fped.2024.1426588. eCollection 2024.

ABSTRACT

OBJECTIVE: The aim of this quality improvement project is to identify children with rheumatologic conditions to prevent delayed or missed diagnosis in underserved pediatric populations. Our focus is on prompt and accurate identification and subsequent treatment of rheumatologic symptoms in pediatric patients referred from Atrium Health safety-net primary care clinics that deliver care to families without private insurance, including those lacking insurance entirely.

METHODS: We collaborated with providers at one safety-net clinic to improve the processes of identification and subspecialty referral, resulting in an increase in the number of identified pediatric patients and referrals for these patients with potential rheumatologic disease. We used the Model for Improvement framework with rapid Plan-Do-Study-Act cycles and evaluated improvement with run and statistical process control charts.

RESULTS: We achieved improvement, with zero referrals in the previous 5 years for the targeted population increasing to 15 patient referrals within 1 year of project initiation. Despite this increase in referrals, the rheumatology clinic was able to see all priority patients within 20 business days from referral.

CONCLUSION: An awareness of concerning rheumatologic symptoms in safety-net primary care clinics, combined with the use of both visual and decision aids, allows care teams to efficiently recognize and accurately refer patients needing specialty care.

PMID:39474606 | PMC:PMC11518760 | DOI:10.3389/fped.2024.1426588

Cureus. 2024 Oct 29;16(10):e72642. doi: 10.7759/cureus.72642. eCollection 2024 Oct.

ABSTRACT

Introduction This study evaluated the impact of Class II composite resin and amalgam restorations on alveolar bone loss in diabetic patients, a population more susceptible to periodontal complications. The main objective was to determine whether the choice of restorative material impacts periodontal health, providing insights to optimize dental care for this high-risk group. Materials and methods This observational, comparative. cross-sectional study included 64 diabetic patients, divided into two groups based on their Class II restorations. Group 1 had 32 patients with composite resin restorations, while Group 2 comprised 32 patients with amalgam restorations. Both groups were matched for age and diabetes duration to ensure comparability. Periodontal health, specifically alveolar bone loss, was assessed through clinical and radiographic evaluations. The study analyzed the impact of the two materials on alveolar bone levels. Results Data from 64 diabetic patients (32 in Group 1 and 32 in Group 2) were statistically analyzed using PASW Statistics for Windows, Version 18.0 (Released 2009; SPSS Inc., Chicago, United States). Three statistical tests, descriptive statistics, two-sample t-test, and analysis of covariance (ANCOVA), were used. The results showed significant differences between the two groups, with composite resin restorations linked to greater alveolar bone loss. Conclusion The choice of restorative material significantly influences periodontal health in diabetic patients. Composite resin restorations were associated with a higher risk of alveolar bone loss and periodontal disease, emphasizing the need for careful material selection and regular periodontal monitoring in diabetic patients.

PMID:39474594 | PMC:PMC11521317 | DOI:10.7759/cureus.72642