Tag: pubmed

World J Gastrointest Surg. 2024 Nov 27;16(11):3437-3444. doi: 10.4240/wjgs.v16.i11.3437.

ABSTRACT

BACKGROUND: With the widespread use of hemocoagulase in patients with gastrointestinal bleeding, clinicians have become increasingly concerned about coagulation disorders associated with this medication. Risk factors for hypofibrinogenemia associated with hemocoagulase are poorly understood.

AIM: To determine risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding.

METHODS: We performed a retrospective analysis of the medical documentation of hospitalized patients treated with hemocoagulase for gastrointestinal bleeding. Hypofibrinogenemia was defined as a decrease in plasma fibrinogen concentration to less than 2.0 g/L. The included patients were divided into two groups: acquired hypofibrinogenemia group and non-hypofibrinogenemia group. We used logistic regression analysis to identify potential risk factors and established risk assessment criteria by employing a receiver operating characteristic curve.

RESULTS: There were 36 patients in the acquired hypofibrinogenemia group and 73 patients in the non-hypofibrinogenemia group. The hypofibrinogenemia group showed higher rates of intensive care unit admissions (P = 0.021), more female patients (P = 0.005), higher in-hospital mortality (P = 0.027), larger hemocoagulase doses (P = 0.026), more Packed Red Cells transfusions (P = 0.024), and lower baseline fibrinogen levels (P < 0.000). Binary logistic regression was employed to examine the risk factors associated with acquired hypofibrinogenemia. The analysis revealed that baseline fibrinogen [odds ratio (OR) 0.252, 95%CI: 0.137-0.464, P < 0.000], total hemocoagulase doses (OR 1.074, 95%CI: 1.015-1.137, P = 0.014), and female gender (OR 2.856, 95%CI: 1.015-8.037, P = 0.047) were statistically significant risk factors.

CONCLUSION: Higher doses of total hemocoagulase, female gender, and a lower baseline fibrinogen level were risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding.

PMID:39649201 | PMC:PMC11622085 | DOI:10.4240/wjgs.v16.i11.3437

SAGE Open Nurs. 2024 Dec 5;10:23779608241299507. doi: 10.1177/23779608241299507. eCollection 2024 Jan-Dec.

ABSTRACT

INTRODUCTION: Pre-hospital care personnel, including paramedics and emergency medical technicians (EMTs), are crucial frontline responders in emergency medical situations. They are critical in delivering timely medical assistance to individuals in emergencies. However, the demanding nature of their work can subject them to significant job stress, which may adversely affect their well-being and job performance.

OBJECTIVES: This study aimed to assess the levels of job stress and explore associated factors among pre-hospital care providers in Addis Ababa.

METHODOLOGY: A cross-sectional study was conducted at a healthcare facility, involving 134 ambulance healthcare providers. Participants were selected through a simple random sampling technique. Data collection employed pretested, self-administered questionnaires utilizing a nursing stress scale. Descriptive statistics were utilized to summarize the findings. Logistic regression analysis was employed to ascertain associations between variables while controlling for potential confounders. The strength of the association between dependent and independent variables was evaluated using odds ratios with a 95% confidence interval.

RESULT: Of the 134 study participants, 47% (95% CI: 38.2, 55.8) of them had job stress. Notably, several factors were significantly associated with job stress among pre-hospital healthcare providers working in ambulances. Conflict with leaders (AOR = 5.07; 95% CI: 2.98, 12.53), fear of mistakes (AOR = 8.22; 95% CI: 1.86, 36.34), lack of resources (AOR = 11.06; 95% CI: 5.19, 22.41), overloaded with ambulance care (AOR = 18.94; 95% CI: 4.33, 38.73) and inadequate information from dispatchers (AOR = 7.35; 95% CI: 3.32, 16.62) were identified as significant associated factors of job stress among these providers. These findings highlight the critical need to address leadership conflicts, fear of errors, and communication deficiencies to mitigate job stress among pre-hospital healthcare providers working in ambulances.

CONCLUSION: This study highlights the prevalence of job stress among pre-hospital healthcare providers working in ambulances, and found it as a significant problem. Notably, conflict with leaders, fear of mistakes, lack of resources, work overload and inadequate information from dispatchers emerged as significant associated factors contributing to job stress among pre-hospital health care providers. Efforts to foster better communication channels between providers and dispatchers, promote supportive leadership practices, and implement error-reduction strategies are essential. By addressing these challenges, healthcare organizations can create a more conducive work environment that supports the mental and emotional health of pre-hospital healthcare providers.

PMID:39649178 | PMC:PMC11622293 | DOI:10.1177/23779608241299507

SAGE Open Nurs. 2024 Dec 5;10:23779608241299345. doi: 10.1177/23779608241299345. eCollection 2024 Jan-Dec.

ABSTRACT

BACKGROUND: Despite free maternal healthcare, about 50% of pregnant women in Ghana initiate their antenatal clinic (ANC) late.

AIM: This study aimed to identify the factors that contribute to the late initiation of ANC among pregnant women in the Jasikan District, Ghana.

METHOD: A cross-sectional study was conducted between December 2021 and May 2022 in multiple health facilities. Multistage sampling was employed to select 352 pregnant women attending ANC in selected health facilities. A structured questionnaire was used to collect the data. The data was analyzed using Stata version 14.0. Descriptive statistics was used to describe the study variables and multivariable logistic regression models were performed to determine the predictors of late ANC initiation at p < .05 and 95% confidence interval (CI).

RESULTS: Approximately 45.7% of the participants initiated ANC late. Age less than 20 years, older age groups (40-49 [odds ratio (OR): 18.0, 95%CI: 3.68-88.0, p < .001]; 30-39 [OR: 6.4, 95%CI: 1.76-22.87, p = .005] and 20-29 [OR: 4.6, 95%CI: 1.30-15.98, p = .018]) were associated with late initiation of ANC. Having a higher number of children (4 [OR: 2.8, 95%CI: 1.36-5.79, p = .005] and 3 [OR: 2.5, 95%CI: 1.33-4.58, p = .004]) were predictors of late ANC initiation as compared to having one child. Women who sought for advice from women leaders (OR: 3.5, 95%CI: 1.18-10.12, p = .02) were about three (3) times more likely to initiate ANC late as compared to those who sought for advice from friends. Women who felt poorly received at ANC (OR: 7.7, 95%CI: 2.188-27.078, p = .001) were about eight (8) times more likely to initiate ANC late as compared to those who felt well received. Again, those who spent over six (6) hours during ANC visits (OR: 18.4, 95%CI: 4.246-79.734, p < .001) had an 18 times higher risk of initiating ANC late relative to those who spent less than 3 h.

CONCLUSION: The study findings highlight the need for interventions that addresses the social and cultural factors, negative perceptions of ANC, and long waiting times at health facilities to improve early initiation of ANC. Such interventions can assume health education and promotion to address the sociocultural and unfavorable perceptions toward ANC. The sector ministry and the health facilities may consider expanding ANC service centers to reduce long waiting times.

PMID:39649177 | PMC:PMC11622304 | DOI:10.1177/23779608241299345

Clin Anat. 2024 Dec 8. doi: 10.1002/ca.24255. Online ahead of print.

ABSTRACT

The accessory renal arteries (ARAs) are a well-described variant of the renal vasculature with clinical implications for radiologists, surgeons, and clinicians. The aim of the present systematic review with meta-analysis was to estimate the pooled prevalence of ARAs, including their variant number, origin, and termination, and to highlight symmetrical and asymmetrical morphological patterns. The systematic review used four online databases in accordance with PRISMA 2020 and Evidence-based Anatomy Workgroup guidelines. R programming software was used for the statistical meta-analysis. A total of 111 studies were considered eligible for our initial aim. The typical renal artery (RA) anatomy (a single bilateral vessel) was identified in 78.92%; the overall ARA prevalence was estimated at a pooled prevalence of 21.10%. The estimated pooled prevalence of one, two, three, and four ARAs were 18.67%, 1.80%, 0.01%, and <0.01%. The ARAs have been the subject of extensive research owing to their clinical importance, including in kidney transplantation surgery and resistant hypertension therapy. Knowledge of the typical and variant anatomy of RAs is essential for anatomists, radiologists, surgeons, and clinicians in order to avoid misunderstanding, complications, and iatrogenic injury.

PMID:39648312 | DOI:10.1002/ca.24255

Nutr Diet. 2024 Dec 8. doi: 10.1111/1747-0080.12917. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to assess the criterion validity of the Global Leadership Initiative on Malnutrition criteria compared to the subjective global assessment in a diverse inpatient population.

METHODS: This cross-sectional study was a retrospective analysis of point prevalence audit data. The prevalence of malnutrition determined by the Global Leadership Initiative on Malnutrition criteria was compared to the Subjective Global Assessment. Validity statistics were determined using all of the Global Leadership Initiative on Malnutrition criteria concurrently as well as each pair that could be used to diagnose malnutrition. Subgroup analysis was undertaken based on severe malnutrition, treatment group, age and body mass index.

RESULTS: Nine hundred and eighty-one patients were included (65.1 ± 18.6 years, 54.8% male). The prevalence of malnutrition was 36.7% using the Subjective Global Assessment and 36.1% using the Global Leadership Initiative on Malnutrition criteria. More patients were classified as severely malnourished using the Global Leadership Initiative on Malnutrition criteria (9.8% vs. 6.0%), whilst more rehabilitation patients were classified as malnourished using the Subjective Global Assessment (42.2% vs. 33.6%). The criterion validity of the Global Leadership Initiative on Malnutrition criteria was good, with a sensitivity of 92.5% (95% CI 90.9-94.2) and specificity of 96.6% (95% CI 95.5-97.8). There was a downward trend in sensitivity with increasing body mass index and a lower sensitivity in the rehabilitation population. The criterion validity was fair at best when each pair of the Global Leadership Initiative on Malnutrition criteria was considered independently of other criteria.

CONCLUSIONS: When all criteria are considered concurrently, the Global Leadership Initiative on Malnutrition criteria present good criterion validity and can be applied in clinical practice to diagnose malnutrition.

PMID:39648307 | DOI:10.1111/1747-0080.12917

Anat Sci Educ. 2024 Dec 8. doi: 10.1002/ase.2540. Online ahead of print.

ABSTRACT

The traditional approach of using PowerPoint (PPT) presentations in medical imaging theory classes hinders the spatial thinking ability of most students. Consequently, the learning outcomes are often unsatisfactory. This article proposes a naked eye three-dimensional (3D) medical imaging teaching assistant app based on augmented reality (AR) technology to enhance learning interest, teaching interaction, and effectiveness. The control group consisted of 50 undergraduate students from the 2018 clinical medicine major who receive traditional teaching, while the experimental group includes 52 undergraduate students from the 2019 cohort who utilize an AR-based naked eye 3D teaching assistant app in addition to traditional teaching methods. Based on Bloom’s cognitive learning taxonomy (Remember, Understand, Apply, Analyze, Evaluate, and Create), corresponding teaching curricula and assessment methods were designed in order to achieve more in-depth learning of the curriculum. The evaluation of the teaching effectiveness between the two groups relied on exam scores and student satisfaction questionnaires, with statistical analyses conducted using t-test and Mann-Whitney U-test in SPSS. The experimental group and control group showed statistically significant differences in the theoretical examination scores (62.06 ± 3.06 vs. 59.82 ± 3.38), practical testing scores (22.90 ± 2.35 vs. 21.06 ± 2.65), and total scores (84.96 ± 4.58 vs. 80.88 ± 6.01). Likert scores showed the experimental group scored significantly higher in enjoyment, satisfaction, participation, efficiency, and understanding. They also reported high convenience scores for the app and desired continued use. The naked eye 3D teaching assistant system is an innovative and effective teaching model for undergraduate medical imaging education, enhancing student interest, student interaction, and teaching effectiveness and promising future applications.

PMID:39648303 | DOI:10.1002/ase.2540

Am J Biol Anthropol. 2024 Dec 8:e25042. doi: 10.1002/ajpa.25042. Online ahead of print.

ABSTRACT

OBJECTIVES: Previous studies report that geometric measures of incisor size and curvature in extant anthropoid primates correspond to dietary differences. However, other methodologies of assessing incisor shape variation, such as dental topographic analysis, have not been considered.

MATERIALS AND METHODS: This study measures Relief Index (RFI), linear dimensions, and curvature of central mandibular incisors (I₁) for a sample of extant anthropoids (n = 107). The utility of these measures in enhancing dietary separations across Anthropoidea is further investigated using traditional and phylogenetic statistics, principal component analysis, and multinomial logistic regression.

RESULTS: Two-way ANOVAs find significant dietary differences and no sexual differences in I₁ height, width, breadth, and RFI across crown anthropoids. Phylogenetic ANOVAs also detect significant dietary differences in these measures despite the presence of high and significant phylogenetic signal in height and RFI, indicating that dietary signals are robust. Predictive models combining I₁ geometry and RFI outperform those using solely I₁ geometry. A mixed-feeding ecology is inferred for the fossil platyrrhine Antillothrix.

DISCUSSION: Our findings indicate that I₁ RFI and linear dimensions are robust dietary proxies in anthropoid primates that may be beneficial to future ecomorphological and paleontological analyses. The presence of phylogenetic signal merits further investigation, and we recommend a nuanced approach if applying I₁ RFI or height as a dietary proxy for fossil primates.

PMID:39648302 | DOI:10.1002/ajpa.25042

Clin Oral Implants Res. 2024 Dec 8. doi: 10.1111/clr.14387. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the performance and clinical outcome of vertical and horizontal bone augmentation (VHBA) in posterior maxillary regions combining lateral window sinus floor elevation (LWSFE) with a horizontal bone shell technique applying the maxillary facial sinus wall as a bone plate.

MATERIALS AND METHODS: In 18 patients, LWSFE was combined with a horizontal bone shield augmentation procedure utilizing the maxillary facial sinus bone wall as a lateral bone plate. Both the sinus cavity and the lateral bone box created were grafted with a mixture of autogenous bone/venous blood and bovine bone mineral. The primary aim was to assess the performance of combined techniques enabling subsequent implant placement. Using radiographic measurements (preoperative, after VHBA, at implant placement, and at follow-up), bone gain/reduction of augmented horizontal ridge width (HRW) and vertical bone height (VBH) were evaluated. Additionally, clinical outcome assessing implant survival/success rate, marginal bone loss (MBL), and implant health (mucositis/peri-implantitis) was evaluated.

RESULTS: For the combined VHBA techniques, HRW and VBH increased significantly (p < 0.001) from preoperative 3.5 ± 1.4 mm/3.6 ± 2.1 mm to 9.7 ± 1.9 mm/18.0 ± 1.6 mm post-augmentation. However, HRW and VBH dimensions decreased up to 8.9 ± 1.8 mm/17.1 ± 1.4 mm at implant placement and 8.6 ± 1.7 mm/16.7 ± 1.3 mm at follow-up evaluation (3.8 ± 1.8 years; p < 0.001, respectively). Augmented bone reduction was significantly higher (-7.7%) between the augmentation procedure and implant placement than in the post-implant-placement period (-2.5%). All implants survived (100%) representing peri-implant MBL of -0.9 ± 0.7 mm, pocket depth of 3.4 + 1.8 mm, and prevalences of 5%/0% for peri-implant mucositis/peri-implantitis.

CONCLUSION: The combination of horizontal bone augmentation using local bone shield transfer from the maxillary facial sinus wall with LWSFE enables sufficient reconstruction of maxillary posterior ridge.

PMID:39648281 | DOI:10.1111/clr.14387

Transfusion. 2024 Dec 8. doi: 10.1111/trf.18090. Online ahead of print.

ABSTRACT

BACKGROUND: Extracorporeal photopheresis (ECP) has been demonstrated as an effective treatment for graft-versus-host disease (GvHD). The inline system was developed by Therakos in 1987. Recently, Fresenius Kabi implemented an integration of cell separator Amicus and a UVA photoactivation device (Phelix), realizing an inline photopheresis system.

STUDY DESIGN AND METHODS: In 2022 we designed a prospective paired crossover trial (NCT05718674) comparing two integrated ECP protocols: Therakos CELLEX and Amicus ECP system. Twenty patients affected by corticosteroid resistant GvHD were submitted to 80 ECP, 40 paired procedures.

RESULTS: All procedures were well tolerated, with no significant differences in procedure duration. CELLEX cell product showed higher granulocytes and platelet content, while Amicus cell product exhibited higher enrichment of lymphocytes, resulting in significantly higher MNC purity (92.9% vs. 84%). A significantly higher granulocytes and platelets absolute content was observed in CELLEX cell products, while Amicus cell products showed a significantly higher number of TNCs and MNCs. Differences in granulocyte and platelet content remained significant even after normalization of the data according to blood volume processed. These findings are confirmed by a statistically significant higher CE2% for CELLEX for granulocytes and platelets along with the lack of significant difference observed for TNCs and MNCs.

DISCUSSION: Our analysis shows differences in the characteristics of the procedure and the cell product. Anyway, both devices are effective for performing ECP procedure, as they collect a cell product suitable for photopheresis. At present, our results represent the first data set comparing two available inline ECP devices.

PMID:39648279 | DOI:10.1111/trf.18090

Drug Dev Ind Pharm. 2024 Dec 8:1-13. doi: 10.1080/03639045.2024.2434640. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study is to create predictive models utilizing machine learning algorithms, including Artificial Neural Networks (ANN), k-nearest neighbor (kNN), support vector machines (SVM), and linear regression, to predict critical quality attributes (CQAs) such as hardness, friability, and disintegration time of fast disintegrating tablets (FDTs).

METHODS: A dataset of 864 batches of FDTs was generated by varying binder types and amounts, disintegrants, diluents, punch sizes, and compression forces. Preprocessing steps included normalizing numerical features based on industry standards, one-hot encoding for categorical variables, and addressing outliers to ensure data consistency. Four machine learning models were trained and evaluated on R² values and mean squared error (MSE). Feature importance was analyzed using permutation importance, and statistical validation (p < 0.05) and confidence intervals were computed for model performance. The ‘differential_evolution’ function was used to optimize the formulation.

RESULTS: Among the models, ANN demonstrated the highest predictive accuracy, achieving R² values up to 0.9550 with the lowest MSE across training and test datasets, outperforming kNN, SVM, and linear regression. The ANN’s ability to model complex, non-linear interactions between formulation variables was statistically significant, as validated through six checkpoint batches of acetylsalicylic acid FDTs. The feature importance analysis revealed compression force, binder type, and punch size as the most influential factors affecting hardness, while disintegrant type influenced friability. The ‘differential_evolution’ function effectively optimized the CQAs, resulting in FDTs with ideal characteristics.

CONCLUSION: The ANN model, integrated with differential evolution, provided a robust tool for optimizing FDT formulations by accurately predicting CQAs and reducing the need for extensive experimental trials. Compared to traditional optimization methods, ANN excels in capturing intricate multi-variable relationships, making it a valuable approach for scaling beyond acetylsalicylic acid to other formulations. This method enhances the consistency and efficiency of tablet formulation, supporting broader pharmaceutical applications.

PMID:39648277 | DOI:10.1080/03639045.2024.2434640