Tag: pubmed

J Am Board Fam Med. 2023 Jun 15:jabfm.2022.220222R3. doi: 10.3122/jabfm.2022.220222R3. Online ahead of print.

ABSTRACT

INTRODUCTION: Home-based primary care (HBPC) has shown promise in the management of multiple chronic conditions for patients who are homebound or who have limited mobility. The objective of this study was to implement and evaluate an HBPC program that integrates the services of clinical pharmacists and community aging services providers in a community-based setting.

METHODS: Mountain Area Health Education Center’s (MAHEC) HBPC program brought together an interdisciplinary team including medical providers, pharmacists, and community aging services providers to conduct home visits with older adults (age 50+). A single-arm, prepost analysis was conducted to determine differences from the year before program enrollment to the year postenrollment. We examined the frequency of health care visits, high-cost health care utilization (emergency department [ED] utilization and hospitalizations), and health care costs. Descriptive statistics characterized the study population and outcomes. Fisher’s Exact Tests were used to determine if there was a significant difference between years.

RESULTS: There were 130 home visits with 62 patients enrolled in the program. The Medicare Annual Wellness Visit (AWV) was completed for 32 (51.6%) patients. There were 13 (21.0%) and 12 (19.4%) individuals who had at least 1 ED visit and hospitalization, respectively, pre-enrollment as compared with 8 (12.9%) and 9 (14.5%) individuals postenrollment (p-value = 0.05, p-value = 0.06). During the postenrollment year, patient enrollees had an average per-member-per-month (PMPM) cost of $1567.96 as compared with $3053.21 in the year prior.

CONCLUSIONS: Pharmacist and community agency services-integrated HBPC was implemented in the community setting. There was a decrease in high-cost health care utilization and total health care expenditures for patients as compared with the previous year.

PMID:37321655 | DOI:10.3122/jabfm.2022.220222R3

Clin Exp Pediatr. 2023 Jun 14. doi: 10.3345/cep.2022.01193. Online ahead of print.

ABSTRACT

BACKGROUND: Intravenous (IV) injection often causes pain, fear, and anxiety in pediatrics. Virtual reality (VR) is a relatively new intervention that can be used to provide distraction during or to prepare patients for IV injections, however, so far no meta-analysis has been conducted to examine the evidence regarding the effectiveness of VR in reducing pain in pediatric IV injection.

METHODS: The search in electronic databases of PubMed, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials was established on 7 August 2022. The methodological quality of the studies was measured by the Delphi checklist. Chi-squared (Chi2) test and measure its quantity by the I2 statistic were applied for measuring the heterogeneity across studies. A summary measure of the mean difference in pain scores between virtual reality and control groups was obtained using a random-effects model. All statistical analyses were set at a significance level of 0.05 using Stata software, version 14.

RESULTS: In total, nine studies were included. Findings reported interventions of virtual reality during intravenous placement among pediatrics. The meta-analysis of the difference in means of the pain score between the intervention and control groups showed significant reductions in the virtual reality group (MD 0.47; 95% CI: 0.3, 0.65; I 2 = 9.1%). There was no heterogeneity among the included studies.

CONCLUSION: Our results suggested that the use of VR is effective in reducing the pain of IV injection in pediatrics. There was no heterogeneity among studies that reported the effectiveness of using VR in reducing IV injection pain in pediatrics. The Delphi checklist was used to measure study quality.

PMID:37321586 | DOI:10.3345/cep.2022.01193

Clin Exp Pediatr. 2023 Jun 14. doi: 10.3345/cep.2021.01466. Online ahead of print.

ABSTRACT

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders found in children and adolescents. The American Academy of Pediatrics (AAP) first published a clinical practice guideline on ADHD in 2000, which was revised in 2011 and re-published together with an accompanying process-of-care algorithm. More recently, the 2019 clinical practice guideline revision was published. Since the 2011 guideline, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), was released. In addition, the Society of Developmental and Behavioral Pediatrics (SDBP) recently released another clinical practice guideline for complex ADHD. Although there are nonessential changes reflected in these updates, a number of changes have still been made; for example, the DSM-5 criteria lowered the diagnostic threshold for ADHD in older teens and adults. Additionally, the criteria were revised to facilitate application to older teens and adults, and a comorbid diagnosis with autism spectrum disorder is now allowed. Meanwhile, the 2019 AAP guideline added the recommendation related to comorbid conditions with ADHD. Lastly, SDBP developed a complex ADHD guideline, covering areas such as comorbid conditions, moderate-to-severe impairment, treatment failure, and diagnostic uncertainty. In addition, other national ADHD guidelines have been published, as have European guidelines for managing ADHD during the Covid-19 pandemic. To facilitate ADHD management in a primary care, it is important to provide and review clinical guidelines and recent updates. In this article, we will review and summarize the recent clinical guidelines and their updates.

PMID:37321571 | DOI:10.3345/cep.2021.01466

Can J Ophthalmol. 2023 Jun 12:S0008-4182(23)00164-3. doi: 10.1016/j.jcjo.2023.05.006. Online ahead of print.

ABSTRACT

OBJECTIVE: This study investigates the association between preoperative intraretinal fluid (IRF) area and preoperative and postoperative best-corrected visual acuity (BCVA) in surgically repaired idiopathic macular holes (MH). This study further evaluates other prognostic indices related to MH repair that may assist clinicians’ understanding of MH operative management.

DESIGN: Retrospective cohort study conducted at a single institution.

PARTICIPANTS: A total of 251 patients who underwent surgery for idiopathic MH between January 2012 and January 2021.

METHODS: Segmentation was performed on ocular coherence tomography scans of 251 eyes with MH and IRF. Associations between IRF area and preoperative and postoperative BCVA at 1, 3, and 6 months, preoperative and postoperative central subfield thickness, MH diameter, staging, closure status, and type of closure were evaluated using Spearman’s correlation analysis.

RESULTS: Preoperative IRF area was moderately correlated with preoperative BCVA (r = -0.32; p < 0.001) and negligibly correlated with postoperative BCVA at 1, 3, and 6 months (r = -0.14, p = 0.026; r = -0.21, p < 0.001; and r = -0.19, p < 0.001, respectively). Preoperative IRF area was strongly correlated with MH minimum linear diameter (r = 0.56; p < 0.001) and MH base diameter (r = 0.65; p < 0.001). Other associations were not statistically significant.

CONCLUSION: Preoperative IRF area in patients with idiopathic MH demonstrated a moderate correlation with preoperative BCVA and a negligible or weak correlation with postoperative BCVA at up to 6 months, suggesting that vision may not have a clinically significant relationship with IRF in the setting of MH.

PMID:37321556 | DOI:10.1016/j.jcjo.2023.05.006

Am J Clin Nutr. 2023 Jun 13:S0002-9165(23)65969-6. doi: 10.1016/j.ajcnut.2023.06.007. Online ahead of print.

ABSTRACT

BACKGROUND: Diets dense in fruits and vegetables are associated with a reduced risk of preeclampsia, but pathways underlying this relationship are unclear. Dietary antioxidants may contribute to the protective effect.

OBJECTIVE: We determined the extent to which the effect of dietary fruit and vegetable density on preeclampsia is due to high intakes of dietary vitamin C and carotenoids.

DESIGN: We used data from 7572 participants in the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (8 US medical centers, 2010‒2013). Usual daily periconceptional intake of total fruits and total vegetables was estimated from a food frequency questionnaire. We estimated the indirect effect of ≥2.5 cups/1000 kcal of fruits and vegetables through vitamin C and carotenoid on the risk of preeclampsia. We estimated these effects using targeted maximum likelihood estimation and an ensemble of machine learning algorithms, adjusting for confounders including other dietary components and health behaviors, and psychological, neighborhood, and sociodemographic factors.

RESULTS: Participants who consumed ≥2.5 cups of fruits and vegetables per 1000 kcal were less likely than those who consumed <2.5 cups/1000 kcal to develop preeclampsia (6.4% versus 8.6%). After confounder adjustment, we observed that higher fruit and vegetable density was associated with 2 fewer cases of preeclampsia (risk difference -2.0, 95% CI -3.9, -0.1) per 100 pregnancies compared with lower density diets. High dietary vitamin C and carotenoid intake was not associated with preeclampsia. The protective effect of high fruit and vegetable density on the risk of preeclampsia and late-onset preeclampsia were not mediated through dietary vitamin C and carotenoids CONCLUSIONS: Evaluating other nutrients and bioactives in fruits and vegetables and their synergy is worthwhile, along with characterizing the effect of individual fruits or vegetables on preeclampsia risk.

PMID:37321543 | DOI:10.1016/j.ajcnut.2023.06.007

Transfus Clin Biol. 2023 Jun 13:S1246-7820(23)00066-6. doi: 10.1016/j.tracli.2023.06.001. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the influence of restrictive and liberal red blood cell suspension (RBCs) transfusions on the prognosis of premature infants and to analyze the influencing factors to provide a reference for the transfusion strategy of preterm infants.

METHODS: Retrospective analysis was conducted on 85 cases of anemic premature infants treated in our center, including 63 cases in the restrictive transfusion group and 22 in the liberal transfusion group.

RESULTS: RBCs transfusions were effective in both groups, and there were no statistically significant differences in post-transfusion hemoglobin and hematocrit between the two groups (P>0.05). The outcome events: the duration of ventilatory support was statistically prolonger in the restrictive group compared with the liberal group (P<0.001); however, the differences in mortality, the increased weight before discharge, and length of stay in the hospital within the two groups were not statistically significant (P=0.237, 0.36 and 0.771, respectively). Univariate survival analysis showed that age, birth weight, Apgar 1 min and Apgar 10 min scores were the influencing factors for death, with P values of 0.035, 0.004, <0.001, and 0.013, respectively; COX regression analysis showed that Apgar 1 min score was an independent factor of the survival time of preterm infants (P=0.002).

CONCLUSION: Compared with the restrictive transfusion group, liberal transfusion patients presented a shorter duration of ventilatory support, which is more beneficial to the prognosis of premature infants.

PMID:37321534 | DOI:10.1016/j.tracli.2023.06.001

J Arthroplasty. 2023 Jun 13:S0883-5403(23)00567-3. doi: 10.1016/j.arth.2023.05.044. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior quadratus lumborum block (AQLB) is one of the compartment blocks and has recently attracted attention as a new method of analgesia for postoperative hip surgery analgesia. This study aimed to compare the analgesic efficacy of AQLB in patients undergoing primary THA.

METHODS: There were 120 patients undergoing primary THA under general anesthesia randomly allocated to receive a femoral nerve block (FNB) or an AQLB. The primary outcome was total morphine consumption over the initial 24-hour postoperative period. Secondary outcomes included the pain score evaluation while at rest and during active and passive motion over the two days following surgery and the manual muscle testing of the quadriceps femoris. The numerical rating scale (NRS) score was used for evaluating the postoperative pain score.

RESULTS: There were no significant differences between the two groups concerning morphine consumption within 24 hours after surgery (P = 0.72). The NRS score at rest and passive motion were similar at all time points (P > .05). However, there was a statistically significant difference in pain reported during the active motion for the FNB group compared to the AQLB (P = 0.04). No significant differences were found between the two groups concerning muscle weakness incidence.

CONCLUSION: Both AQLB and FNB demonstrated adequate efficacy for postoperative analgesia at rest in THA. However, based on our study, whether AQLB is inferior or non-inferior to FNB as an analgesic method for THA was inconclusive.

PMID:37321519 | DOI:10.1016/j.arth.2023.05.044

J Allergy Clin Immunol Pract. 2023 Jun 13:S2213-2198(23)00655-4. doi: 10.1016/j.jaip.2023.06.011. Online ahead of print.

ABSTRACT

BACKGROUND: Little is known regarding the impact of race, ethnicity, and socioeconomic status on the health outcomes of children with Eosinophilic esophagitis (EoE).

OBJECTIVE: To 1) identify demographic characteristics of children diagnosed with EoE in a large tertiary care center, and 2) determine associations between a patient’s demographics and depth of evaluation or treatment choices.

METHODS: This retrospective cohort study included children 0-18 years old seen in Children’s Hospital Colorado between January 1, 2009 and December 31, 2020. Demographics were extracted from the electronic medical record. Rural-Urban Commuting Area taxonomy codes were used to classify urbanization. Area Deprivation Index (ADI) scores were used to categorize neighborhood advantage/disadvantage. Data were analyzed using descriptive statistics and regression analysis.

RESULTS: The study included 2,117 children with EoE. Children with higher state ADI scores (greater neighborhood disadvantage) had less radiographic evaluation of their disease (OR (95% CI) per unit increase in state ADI = 0.93 (0.89, 0.97), p=.0002) and had esophageal dilations at younger ages (r = -0.24, p=.007). Black children when compared to White children were younger at diagnosis (8.3 versus 10.0 years, p=.002). Children from rural areas were seen less by feeding therapy (3.9% versus 9.9%, p=.02) but were younger at their visits (2.3 versus 4.3 years old, p<.001).

CONCLUSION: In this study of children with EoE cared for in a large tertiary care center, we found differences in presentation and care depending on race, urbanization, and socioeconomic status.

PMID:37321391 | DOI:10.1016/j.jaip.2023.06.011

Magn Reson Imaging. 2023 Jun 13:S0730-725X(23)00100-5. doi: 10.1016/j.mri.2023.06.005. Online ahead of print.

ABSTRACT

Chemical exchange saturated transfer (CEST) MRI has biomarker potential to assess tissue microenvironment in brain tumors. Multi-pool Lorentzian or spinlock models provides useful insights into the CEST contrast mechanism. However, T₁ contribution to the complex overlapping effects of brain tumors is difficult under the non-equilibrium state. Therefore, this study evaluated T₁ contributions on multi-pool parameters with quasi-steady-state (QUASS) algorithm reconstructed equilibrium data. MRI scans were performed in rat brain tumor models, including relaxation, diffusion, and CEST imaging. A pixel-wise seven-pool spinlock-model was employed to fit QUASS reconstructed CEST Z-spectra and evaluated the magnetization transfer (MT), amide, amine, guanidyl, and nuclear-overhauled effect (NOE) signals in tumor and normal tissues. In addition, T₁ was estimated from the spinlock-model fitting and compared with measured T₁. We observed tumor had a statistically significant increase in the amide signal (p < 0.001) and decreases in the MT and NOE signals (p < 0.001). On the other hand, the differences in amine and guanidyl between the tumor and contralateral normal regions were not statistically significant. The differences between measured and estimated T₁ values were 8% in the normal tissue and 4% in the tumor. Furthermore, the isolated MT signal strongly correlated with R₁ (r = 0.96, P < 0.001). In summary, we successfully unraveled multi-factorial effects in the CEST signal using spinlock-model fitting and QUASS method and demonstrated the effect of T₁ relaxation on MT and NOE.

PMID:37321379 | DOI:10.1016/j.mri.2023.06.005

Magn Reson Imaging. 2023 Jun 13:S0730-725X(23)00101-7. doi: 10.1016/j.mri.2023.06.003. Online ahead of print.

ABSTRACT

New or enlarged lesions in malignant gliomas after surgery and chemoradiation can be associated with tumor recurrence or treatment effect. Due to similar radiographic characteristics, conventional-and even some advanced MRI techniques-are limited in distinguishing these two pathologies. Amide proton transfer-weighted (APTw) MRI, a protein-based molecular imaging technique that does not require the administration of any exogenous contrast agent, was recently introduced into the clinical setting. In this study, we evaluated and compared the diagnostic performances of APTw MRI with several non-contrast-enhanced MRI sequences, such as diffusion-weighted imaging, susceptibility-weighted imaging, and pseudo-continuous arterial spin labeling. Thirty-nine scans from 28 glioma patients were obtained on a 3 T MRI scanner. A histogram analysis approach was employed to extract parameters from each tumor area. Statistically significant parameters (P < 0.05) were selected to train multivariate logistic regression models to evaluate the performance of MRI sequences. Multiple histogram parameters, particularly from APTw and pseudo-continuous arterial spin labeling images, demonstrated significant differences between treatment effect and recurrent tumor. The regression model trained on the combination of all significant histogram parameters achieved the best result (area under the curve = 0.89). We found that APTw images added value to other advanced MR images for the differentiation of treatment effect and tumor recurrence.

PMID:37321378 | DOI:10.1016/j.mri.2023.06.003