Tag: pubmed

Nurse Educ. 2023 Nov 22. doi: 10.1097/NNE.0000000000001585. Online ahead of print.

ABSTRACT

BACKGROUND: Nursing education is moving toward competency-based education and assessment. Nurse educators will need to adopt strategies to develop and measure competence.

PURPOSE: The purpose of this study was to determine if screen-based virtual patient simulation is an effective strategy to assist learners in developing competencies and subcompetencies required in nursing practice.

METHODS: Thirteen questions (6 assessment and clinical reasoning focused, 4 clinical judgment focused, 3 attitude and socialization to nursing focused), aligned with the competencies of the American Association of Colleges of Nursing Essentials, were developed for a pre-/posttest design to evaluate student competency development.

RESULTS: Senior nursing students (n = 52) participated; 1-tailed paired t test identified 12 of 13 items as statistically significant. Posttest scores were greater than pretest scores.

CONCLUSIONS: The change in mean scores from pre- to posttest suggests screen-based virtual patient simulation scenarios improve learners’ competence in addressing the patient’s physical and psychological comfort and decreased caregiver biases.

PMID:37994457 | DOI:10.1097/NNE.0000000000001585

Dis Colon Rectum. 2023 Nov 16. doi: 10.1097/DCR.0000000000003111. Online ahead of print.

ABSTRACT

BACKGROUND: Loop ileostomy closure is a common procedure in colorectal surgery. Often seen as a simple operation associated with low complication rates, it still leads to lengthy hospitalizations. Reducing postoperative complications and ileus rates could lead to a shorter length of stay and even ambulatory surgery.

OBJECTIVES: This study aimed to assess the safety and feasibility of ileostomy closure performed in a 23-hour hospitalization setting using a standardized enhanced recovery pathway.

DESIGN: Randomized controlled trial.

SETTINGS: Two high-volume colorectal surgery centers.

PATIENTS: Healthy adults undergoing elective ileostomy closure, from July 2019 to January 2022.

INTERVENTION: All patients were enrolled in a standardized enhanced recovery pathway specific to ileostomy closure including daily irrigation of efferent limb with a nutritional formula for 7 days prior to surgery. Patients were randomly allocated to either conventional hospitalization (n = 23) or a 23-hour stay (n = 24).

MAIN OUTCOME MEASURES: Primary outcome was total length of stay and secondary outcomes were 30-day rates of readmission, postoperative ileus, surgical site infections, postoperative morbidity and mortality.

RESULTS: A total of 47 patients were ultimately randomized. Patients in the 23-hour hospitalization arm had a shorter median length of stay (1 day vs. 2 days, p = 0.02) and similar rates of readmission (4% vs. 13%, p = 0.35), postoperative ileus (none in both arms), surgical site infection (0 vs. 4%, p = 0.49), postoperative morbidity (21% vs. 22%, p = 1.00) and mortality (none in both arms).

LIMITATIONS: Due to COVID-19, access to surgical beds was greatly limited, leading to a shift toward ambulatory surgery for ileostomy closure. The study was terminated early, which affected its statistical power.

CONCLUSION: Loop ileostomy closures as 23-hour stay procedures are feasible and safe. Ileus rate might be reduced by preoperative intestinal stimulation with nutritional formula through stoma’s efferent limb, although specific RCTs are needed to confirm this association.

PMID:37994456 | DOI:10.1097/DCR.0000000000003111

Ren Fail. 2023;45(2):2285865. doi: 10.1080/0886022X.2023.2285865. Epub 2023 Nov 23.

ABSTRACT

OBJECTIVE: Identifying patients at high risk for cardiac arrest-associated acute kidney injury (CA-AKI) helps in early preventive interventions. This study aimed to establish and validate a high-risk nomogram for CA-AKI.

METHODS: In this retrospective dataset, 339 patients after cardiac arrest (CA) were enrolled and randomized into a training or testing dataset. The Student’s t-test, non-parametric Mann-Whitney U test, or χ2 test was used to compare differences between the two groups. Optimal predictors of CA-AKI were determined using the Least Absolute Shrinkage and Selection Operator (LASSO). A nomogram was developed to predict the early onset of CA-AKI. The performance of the nomogram was assessed using metrics such as area under the curve (AUC), calibration curves, decision curve analysis (DCA), and clinical impact curve (CIC).

RESULTS: In total, 150 patients (44.2%) were diagnosed with CA-AKI. Four independent risk predictors were identified and integrated into the nomogram: chronic kidney disease, albumin level, shock, and heart rate. Receiver operating characteristic (ROC) analyses showed that the nomogram had a good discrimination performance for CA-AKI in the training dataset 0.774 (95%CI, 0.715-0.833) and testing dataset 0.763 (95%CI, 0.670-0.856). The AUC values for the two groups were calculated and compared using the Hanley-McNeil test. No statistically significant differences were observed between the groups. The calibration curve demonstrated good agreement between the predicted outcome and actual observations. Good clinical usefulness was identified using DCA and CIC.

CONCLUSION: An easy-to-use nomogram for predicting CA-AKI was established and validated, and the prediction efficiency of the clinical model has reasonable clinical practicability.

PMID:37994450 | DOI:10.1080/0886022X.2023.2285865

Dis Colon Rectum. 2023 Nov 16. doi: 10.1097/DCR.0000000000003050. Online ahead of print.

ABSTRACT

BACKGROUND: Anastomotic leakage after anterior resection for rectal cancer is more common after total compared to partial mesorectal excision but might be mitigated by a defunctioning stoma.

OBJECTIVE: The aim is to assess how anastomotic leakage is affected by type of mesorectal excision and defunctioning stoma use.

DESIGN: This is a retrospective multicenter cohort study evaluating anastomotic leakage after anterior resection. Multivariable Cox regression with hazard ratios and 95% confidence intervals was employed to contrast mesorectal excision types and defunctioning stoma use with respect to anastomotic leakage, with adjustment for confounding.

SETTINGS: This multicenter study included patients from 11 Swedish hospitals between 2014 and 2018.

PATIENTS: Patients who underwent anterior resection for rectal cancer were included.

MAIN OUTCOMES MEASURES: Anastomotic leakage rates within and after 30 days of surgery are described up to one year after surgery.

RESULTS: Anastomotic leakage occurred in 24.2% and 9.0% of 1126 patients operated with total and partial mesorectal excision, respectively. Partial compared to total mesorectal excision was associated with a reduction in leakage, with an adjusted HR of 0.46 (95% CI: 0.29-0.74). Early leak rates within 30 days were 14.9% with and 12.5% without a stoma, while late leak rates after 30 days were 7.5% with and 1.9% without a stoma. After adjustment, defunctioning stoma was associated with a lower early leak rate (HR 0.47; 95% CI: 0.28-0.77). However, the late leak rate was non-significantly higher in defunctioned patients (HR 1.69; 95% CI: 0.59-4.85).

LIMITATIONS: This study was limited by its retrospective observational study design.

CONCLUSIONS: Anastomotic leakage is common up to one year after anterior resection for rectal cancer, where partial mesorectal excision is associated with a lower leak rate. Defunctioning stomas seem to decrease the occurrence of leakage, though partially by only delaying the diagnosis.

PMID:37994449 | DOI:10.1097/DCR.0000000000003050

Ren Fail. 2023;45(2):2278298. doi: 10.1080/0886022X.2023.2278298. Epub 2023 Nov 23.

ABSTRACT

Patients with chronic kidney disease (CKD) have high morbidity and mortality, and the disease progression has a significant impact on their survival and living standards. This research aims to analyze risk factors for CKD stage 1 and provide a reference for clinical decision making. The clinical data and peripheral blood samples of 300 patients with CKD stage 1 were collected retrospectively. Patients were randomly assigned into a training set (n = 210) and a validation set (n = 90). Patients’ baseline characteristic levels were subjected to statistical tests for difference. Univariate and multivariate Cox regression analyses were utilized to identify risk factors influencing disease progression. Subsequently, a prediction model for disease progression was developed using a nomogram, and the model’s accuracy was assessed using the C-index and calibration curve. The results revealed that hypertension, diabetes, and urinary albumin were essential factors in the progression of CKD stage 1. The nomogram was constructed and then the C-index was calculated. The calibration curve was utilized to assess the risk model. The C-index of the training set was 0.75, and the C-index of the validation set was 0.73, suggesting a good predictive ability of the model. The risk model accurately predicted the progression of CKD stage 1, which is of great significance to developing personalized treatment for patients in clinical practice.

PMID:37994438 | DOI:10.1080/0886022X.2023.2278298

Dermatol Surg. 2023 Nov 15. doi: 10.1097/DSS.0000000000003995. Online ahead of print.

ABSTRACT

BACKGROUND: There are many different autologous grafts used for lip augmentation, such as fat, fascia, or dermofat grafts (DFG). However, filling with synthetic materials such as hyaluronic acid (HA) fillers is the most preferred method.

OBJECTIVE: The authors aimed to compare DFG with HA fillers regarding cost, permanence, complication rate, gained volume, and satisfaction rate. The authors investigated the effect of tie-over dressings on the viability of DFG.

PATIENTS AND METHODS: Patients who received hyaluronic acid fillers were referred to as Group H. Patients who received grafts without tie-over and with tie-over dressings formed Groups D1 and D2, respectively. The lip index (LI) was used for volume comparisons. The viable area of the grafts was measured using ultrasound imaging.

RESULTS: At postoperative month 6, the only significant difference was found between Group D1 and Group D2 (p < .05). At the postoperative first year, Groups D1 and D2 had a statistically higher LI value compared with Group H. Group D2 had a higher viable area than Group D2 (p < .05). Group H and Group D2 showed higher satisfaction scores than Group D1 (p < .05).

CONCLUSION: Dermofat grafts with or without tie-over dressings can be considered a reliable and inexpensive choice for patients who seek a more permanent procedure. Tie-over dressings increase the predictability of DFG and reduce the need for overcorrection.

PMID:37994437 | DOI:10.1097/DSS.0000000000003995

BMC Public Health. 2023 Nov 22;23(1):2309. doi: 10.1186/s12889-023-17218-x.

ABSTRACT

OBJECTIVE: To establish the exponential smoothing prediction model and SARIMA model to predict the number of inpatients in a third-class hospital in Zhejiang Province, and evaluate the prediction effect of the two models, and select the best number prediction model.

METHODS: The data of hospital admissions from January 2019 to September 2022 were selected to establish the exponential smoothing prediction model and the SARIMA model respectively. Then compare the fitting parameters of different models: R²_adjusted, R², Root Mean Square Error (RMSE)、Mean Absolute Percentage Error (MAPE)、Mean Absolute Error(MAE) and standardized BIC to select the best model. Finally, the established model was used to predict the number of hospital admissions from October to December 2022, and the prediction effect of the average relative error judgment model was compared.

RESULTS: The best fitting exponential smoothing prediction model was Winters Addition model, whose R²_adjusted was 0.533, R² was 0.817, MAPE was 6.133, MAE was 447.341. The best SARIMA model is SARIMA(2,2,2)(0,1,1)₁₂ model, whose R²_adjusted is 0.449, R² is 0.199, MAPE is 8.240, MAE is 718.965. The Winters addition model and SARIMA(2,2,2)(0,1,1)₁₂ model were used to predict the number of hospital admissions in October-December 2022, respectively. The results showed that the average relative error was 0.038 and 0.015, respectively. The SARIMA(2,2,2)(0,1,1)₁₂ model had a good prediction effect.

CONCLUSION: Both models can better fit the number of admissions, and SARIMA model has better prediction effect.

PMID:37993836 | DOI:10.1186/s12889-023-17218-x

BMC Microbiol. 2023 Nov 22;23(1):361. doi: 10.1186/s12866-023-03117-z.

ABSTRACT

BACKGROUND: In investigating of (exopolysaccharide) EPS from unconventional sources, lactic acid bacteria have a vital role due to their generally recognized as safe (GRAS) status. EPSs have diverse applications such as drug delivery, antimicrobial activity, surgical implants, and many more in many sectors. Despite being important, the main hindrance to the commercial application of these significant biopolymers is low productivity. Therefore, this study primarily focuses on optimizing physio-chemical conditions to maximize the previously produced EPS from probiotic Lactiplantibacillus plantarum RO30 (L. plantarum RO30) using one factor at a time (OFAT) and method Response Surface Methodology (RSM).

RESULTS: The EPS obtained from L. plantarum RO30 named REPS. The medium formulation for REPS production using the OFAT method revealed that sucrose (20 g/L, beef extract (25 g/L), and ammonium sulfate at 4 g/L concentration were the optimum carbon, organic and inorganic nitrogen sources, and REPS yield was increased up to 9.11 ± 0.51 g/L. RSM experiments revealed that, a greatly significant quadratic polynomial attained from the Central Composite Design (CCD) model was fruitful for specifying the most favorable cultural conditions that have significant consequences on REPS yield. The maximal amount of REPS (10.32 g/L) was formed by: sucrose (40 g/L), beef extract (25 g/L), pH (5.5), incubation temperature (30 °C), and incubation period (72 h). A high closeness was obtained between the predicted and experimental values and it displayed the efficiency of the RSM.

CONCLUSION: This study was conducted to reinforce REPS production in the probiotic LAB L. plantarum RO30 by utilizing various experimental parameters. The maximum REPS yield of 10.32 g/L was attained under the circumstances optimized in the study.

PMID:37993835 | DOI:10.1186/s12866-023-03117-z

BMC Ophthalmol. 2023 Nov 22;23(1):480. doi: 10.1186/s12886-023-03227-2.

ABSTRACT

BACKGROUND: The spatial position of the lens in patients with cortical age-related cataract (CARC) is unclear. We investigated a basis for the assessment of visual quality after cataract surgery by analysing the ultrasound biomicroscopic characteristics of the biological parameters of the lens in patients with CARC.

METHODS: In this retrospective study, 119 patients (50 males and 69 females, totalling 238 eyes) with CARC who underwent simple cataract surgery were selected. The lens thickness (LT), axial length (AL), anterior chamber depth (ACD), lens vault (LV), trabecular-iris angle (TIA), iris-lens angle (ILA), iris-lens contact distance (ILCD) were measured by A-scan ultrasound and ultrasound biomicroscopy. The corresponding lens position (LP) and relative lens position (RLP) were calculated.

RESULTS: LP was greater in men than in women (P < 0.05), LV was smaller in men than in women (P = 0.002), ILA and ILCD were not statistically significant (P = 0.072 and P = 0.854, respectively). There were significant differences in TIA, ILA, and ILCD in the four quadrants (all P < 0.05), with a trend in the distribution of TIA: superior < inferior < nasal < temporal, ILA: nasal < inferior < temporal < superior, and ILCD: superior < temporal < inferior < nasal.

CONCLUSIONS: The lens protrudes more obviously in females than in males and the lens tilts to a certain extent with the increase of age and tends to be more upward and temporal in the supine position. Therefore, trends in lens-related parameters in patients with CARC should be taken seriously.

PMID:37993828 | DOI:10.1186/s12886-023-03227-2

BMC Public Health. 2023 Nov 22;23(1):2313. doi: 10.1186/s12889-023-17156-8.

ABSTRACT

BACKGROUND: A major societal trend of the twenty-first century is the rapidly ageing population as a consequence of the decline in fertility and increase in life expectancy. Along with the rise in ageing population, the burden of obesity and related non-communicable diseases is also equally rising. In this study, we aimed to investigate the potential gender-specific determinants of overweight and obesity among older adults in India.

SUBJECTS AND METHODS: The present study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total sample of 25,952 older adults (≥ 60 years) was selected for the study. Descriptive statistics, bivariate chi-square test, and logistic regression estimation were applied to accomplish the study objectives. Body mass index (BMI) has been classified in this study according to the WHO criteria.

RESULTS: The prevalence of overweight was higher among women (18.15% in rural areas and 46.62% in urban areas) compared to men (12.9% in rural areas and 30.61% in urban areas). Similarly, obesity was higher among women than men who were residing in urban areas (17.07% vs. 5.37%), had secondary or above education (32.38% vs. 6.1%) belonged to richest strata (16.37% vs. 4.50%), or had mobility impairment (9.2% vs. 2.8%). Despite adjustment for several confounders, women were more likely to be overweight (OR: 2.18; CI: 1.86, 2.55) and obese (OR: 3.79; CI: 2.86, 5.03) than men. However, among both the elderly men and women, those who were highly educated were 2.29 times (OR: 2.29; CI: 1.80, 4.11) and 2.71 times (OR: 2.71; CI: 1.78, 4.11), respectively more likely to be overweight than their illiterate counterparts. Older adults living in urban areas were more likely to suffer from obesity compared to rural men (OR: 1.47; CI: 1.07, 2.02) and women (OR: 2.58; CI: 1.85, 3.60). Both men and women, who were highly educated were 2.64 times (OR: 2.64; CI: 1.71, 4.09) and 2.94 times (OR: 2.94; CI: 1.40, 6.20), respectively, more likely to be obese than their illiterate counterparts. Older men and women who were richest (OR: 1.60; CI: 1.19, 2.14 & OR: 2.12; CI: 1.63,2.76), or had mobility impairment (OR: 1.33; CI: 1.09,1.61 & OR: 1.72; CI: 1.42,2.08) were more likely to be overweight than their counterparts who were poorest or did not have any mobility limitation, respectively.

CONCLUSIONS: This study found increased vulnerability of overweight and obesity among older women than men irrespective of their socioeconomic, demographic, and health status. The present study suggests that introducing preventative measures such as campaigns to encourage physical activity, and community awareness may help reduce the high burden of overweight and obesity. Finally, the findings are important for better functioning of any public health programme and suitable intervention techniques to maintain a healthy body in order to lower the prevalence and risk factors of non-communicable diseases in later life.

PMID:37993827 | DOI:10.1186/s12889-023-17156-8