Tag: pubmed

Kardiol Pol. 2022 Jun 20. doi: 10.33963/KP.a2022.0150. Online ahead of print.

ABSTRACT

BACKGROUND: The left circumflex (Cx) artery is the most challenging of coronary branches in terms of diagnostics because the clinical presentation and electrocardiography (ECG) results do not always suggest critical occlusion despite its presence. Therefore, it is important to determine the factors contributing to the clinical manifestation and outcome, such as culprit location.

AIMS: To determine the relation between the location of the culprit plaque and clinical outcomes in the LCx artery.

METHODS: Data from the Polish Registry of Invasive Cardiology Procedures (ORPKI) concerning percutaneous coronary intervention (PCI) procedures have been extracted and analyzed using appropriate statistical tests.

RESULTS: Patients with proximal occlusion received a worse grade using the Killip score. Patients with thrombolysis in myocardial infarction (TIMI) score 0 presented worse clinical presentation in each of the occlusion locations. Periprocedural cardiac arrest and death rate was the highest among patients with proximal Cx occlusion. Death rate among patients with proximal occlusion and non ST segment elevation myocardial infarction (NSTEMI) was greater than among patients with distal occlusion and ST segment elevation myocardial infarction (STEMI).

CONCLUSIONS: Among patients with proximal occlusions of the Cx artery and TIMI 0 grade flow in initial angiogram, a STEMI-like approach should be undertaken apart from initial ECG findings. This is driven by a higher rate of critical and fatal complications such as cardiac arrest and periprocedural death. Fatal complications occur more often in patients with proximal occlusion of Cx than in medial or distal occlusion. Grade IV according to the Killip score can suggest proximal culprit location.

PMID:35724333 | DOI:10.33963/KP.a2022.0150

Nurs Ethics. 2022 Jun 20:9697330221105636. doi: 10.1177/09697330221105636. Online ahead of print.

ABSTRACT

BACKGROUND: The global COVID-19 pandemic has challenged nurse leaders in ways that one could not imagine. Along with ongoing priorities of providing high quality, cost-effective and safe care, nurse leaders are also committed to promote an ethical climate that support nurses’ moral courage for sustaining excellence in patient and family care.

AIM: This study is directed to develop a structure equation model of crisis, ethical leadership and nurses’ moral courage: mediating effect of ethical climate during COVID-19.

ETHICAL CONSIDERATION: Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University, Egypt.

METHODS: A cross-sectional design was used to conduct this study using validated scales to measure the study variables. It was conducted in all units of two isolated hospitals in Damanhur, Egypt. A convenient sample of 235 nurses was recruited to be involved in this study.

RESULTS: This study revealed that nurses perceived a moderate mean percent (55.49 ± 3.46) of overall crisis leadership, high mean percent (74.69 ± 6.15) of overall ethical leadership, high mean percent (72.09 ± 7.73) of their moral courage, and moderate mean percent of overall ethical climate (65.67 ± 12.04). Additionally, this study declared a strong positive statistical significant correlation between all study variables and indicated that the independent variable (crisis and ethical leadership) can predict a 0.96, 0.6, respectively, increasing in the dependent variable (nurses’ moral courage) through the mediating impact of ethical climate.

CONCLUSION: Nursing administrators should be conscious of the importance of crisis, ethical leadership competencies and the role of ethical climate to enhance nurses’ moral courage especially during pandemic. Therefore, these findings have significant contributions that support healthcare organizations to develop strategies that provide a supportive ethical climate. Develop ethical and crisis leadership competencies in order to improve nurses’ moral courage by holding meetings, workshops, and allowing open dialogue with nurses to assess their moral courage.

PMID:35724327 | DOI:10.1177/09697330221105636

Perfusion. 2022 Jun 20:2676591221108811. doi: 10.1177/02676591221108811. Online ahead of print.

ABSTRACT

BACKGROUND: Acute submassive a massive pulmonary embolism are known as leading causes of cardiovascular morbidity and mortality in emergency departments. Choosing the optimal type of catheter directed thrombolysis (CDT) for treatment of pulmonary embolism presents a quandary to the practitioners. To the best of our knowledge, there is no meta-analysis comparing superiority of conventional CDT and ultrasound-accelerated catheter directed thrombolysis (USACDT). Therefore, in this meta-analysis, we aimed to compare conventional CDT with USACDT regarding clinical outcomes and safety profile.

METHODS: A systematic literature search of previous published studies comparing conventional CDT with USACDT regarding clinical outcomes and safety profile was carried out in the electronic databases including MEDLINE, Scopus, EBSCO, Google Scholar, Web of Science, and Cochrane from inception to December 2021. Data were analyzed by comprehensive meta-analysis software (CMA, version 3).

RESULTS: The meta-analysis included nine studies with a total of 705 patients. Our meta-analysis showed that there is no significant difference between two groups with respect to pulmonary arterial systolic pressure (SMD: -0.084; 95% CI: -0.287 to 0.12; p: 0.41), RV/LV (SMD: -0.003; 95% CI: -0.277 to 0.270; p: 0.98), and Miller score (SMD: -0.345; 95% CI: -1.376 to 0.686; p: 0.51). Similarly, we found no statistically significant differences between two groups regarding major and minor bleeding (p > .05).

CONCLUSION: Our meta-analysis showed that when compared with USACDT, conventional CDT provides similar clinical and hemodynamic outcomes or safety for treatment of pulmonary embolism without the need for very expensive technologies. However, randomized clinical trials are required to further investigate cost-effectiveness of USACDT in comparison with conventional CDT.

PMID:35724310 | DOI:10.1177/02676591221108811

IEEE J Biomed Health Inform. 2022 Jun 20;PP. doi: 10.1109/JBHI.2022.3184870. Online ahead of print.

ABSTRACT

Cervical spondylotic myelopathy (CSM) has a high incidence in the middle-aged and elderly people. According to clinical research, there is a connection between hand dexterity and cervical nerves. So the surgeon makes a preliminary assessment of the severity of CSM based on a 10-second grip and release (G&R) test. At present, the statistics of G&R test rely on the surgeon’s manual counting. When a patient’s hand motion speed is too fast, the surgeon’s manual counting is prone to error, leading to potential misdiagnosis. On the other hand, in recent years, artificial intelligence has been developed rapidly, where three-dimensional convolutional neural networks (3D-CNNs) have been widely used in video analysis. This work proposes a hand motion analysis model using a 3D-CNN combined with a de-jittering mechanism to assess the severity of CSM on 10-second G&R videos. We collect 1500 10-second G&R videos recorded by 750 subjects to establish a dataset. The proposed model using 3D-MobileNetV2 as the classifier obtains a Levenshtein accuracy of 97.40% and an average GPU inference time of 3.31 seconds for each 10-second G&R video. Such accuracy and inference speed ensure that the proposed model can be used as a screening examination tool for CSM and a medical assistance tool to help decision making during CSM treatment planning.

PMID:35724286 | DOI:10.1109/JBHI.2022.3184870

Acta Otolaryngol. 2022 Jun 20:1-5. doi: 10.1080/00016489.2022.2085885. Online ahead of print.

ABSTRACT

BACKGROUND: Markers of tumorigenesis are essential factors which may play a major role in the early detection of head and neck carcinoma.

AIMS/OBJECTIVES: To assess concentration of HIF-1, GLUT1 and VEGF in tissue samples and blood serum and its correlation to the tumour size, nodal disease, pathologic differentiation and patients’ data.

MATERIAL AND METHODS: Fifty-two patients diagnosed with laryngeal carcinoma stage I-IV in which concentration of HIF-1, GLUT1 and VEGF was assessed in tissue samples and blood serum using immunoassay method.

RESULTS: HIF-1α, GLUT1, VEGF concentration was significantly higher in cancer tissue samples than in normal tissue (p < .001) and benign laryngeal lesions. Serum levels of the factors were significantly lower in the control group. Statistically significant difference regarding tumour size was found between T2 and T4 stages in HIF-1α concentration in cancer samples and serum.

CONCLUSIONS: The results show that high concentration of HIF-1α, GLUT1 and VEGF might be suggestive of carcinogenic process when diagnosing patients with laryngeal lesions and could promote early detection of malignancy.

SIGNIFICANCE: The results of this study show importance of biochemical assessment in malignant tumours which may affect clinical decisions.

PMID:35724238 | DOI:10.1080/00016489.2022.2085885

Sante Publique. 2022;33(6):853-862. doi: 10.3917/spub.216.0853.

ABSTRACT

INTRODUCTION: Retention of healthcare workers (HCWs) in the healthcare system during the COVID-19 pandemic could become a challenge. It is therefore important to better understand what are the motivational elements that could explain a greater or lesser motivation to care for infected patients.

OBJECTIVES: To evaluate factors modulating HCWs’ willingness to treat COVID-19 infected patients.

METHODS: HCWs from Québec, Canada, were invited to complete an online survey during the first wave of the COVID-19 pandemic between the months of April and July 2020. The survey focused on the intention to avoid treating infected patients, prior experiences in treating COVID-19 patients and anxiety levels. Descriptive statistics and multiple regression analysis were used to assess which factors explained differences in HCWs intention to avoid treating patients.

RESULTS: A total of 430 HCW completed the survey. A majority were women (87%) and nurses (50%). Of those, 12% indicated having considered measures to avoid working with COVID-19 infected patients and 5% indicated having taken actions to avoid working with infected patients. A further 18% indicated that they would use a hypothetical opportunity to avoid working with infected patients. Having previously treated infected patients was associated with a significant reduction in the intention to avoid work (OR: 0.56 CI 0.36-0.86). Amongst HCWs, physicians had a significantly reduced intention to avoid treating infected patients (OR: 0.47 CI 0.23-0.94). We also found that an increase in anxiety score was associated with a greater intention to avoid treating COVID-19 infected patients (OR: 1.06 CI 1.04-1.08).

CONCLUSION: Study results suggest that previous experience in treating COVID-19 infected patients is protective in terms of work-avoidance intentions. We also found that amongst HCWs, physicians had a significantly lower intention to avoid working with COVID-19 infected patients. Finally, our results show that increase in anxiety is associated with a higher intention to avoid treating infected patients. Characterization of factors associated with low anxiety levels and low reluctance to work during the COVID-19 pandemic could be useful in staffing facilities during the present and future healthcare crisis.

PMID:35724190 | DOI:10.3917/spub.216.0853

Adv Skin Wound Care. 2022 Jul 1;35(7):386-393. doi: 10.1097/01.ASW.0000831080.51977.0b.

ABSTRACT

OBJECTIVE: This systematic review assesses the effects of care bundles on the incidence of surgical site infections (SSIs).

DATA SOURCES: The search was conducted between February and May 2021, using PubMed, CINAHL, SCOPUS, Cochrane, and EMBASE databases.

STUDY SELECTION: Studies were included if they used systematic review methodology, were in English, used a quantitative design, and explored the use of care bundles for SSI prevention. A total of 35 studies met the inclusion criteria, and 26 provided data conducive to meta-analysis.

DATA EXTRACTION: Data were extracted using a predesigned extraction tool, and analysis was undertaken using RevMan (Cochrane, London, UK). Quality appraisal was undertaken using evidence-based librarianship.

DATA SYNTHESIS: The mean sample size was 7,982 (median, 840) participants. There was a statistically significant difference in SSI incidence in favor of using a care bundle (SSI incidence 4%, 703/17,549 in the care bundle group vs 7%, 1,157/17,162 in the usual care group). The odds ratio was 0.55 (95% confidence interval, 0.41-0.73; P < .00001), suggesting that there is a 45% reduction in the odds of SSI development for the care bundle group. The mean validity score for all studies was 84% (SD, 0.04%).

CONCLUSIONS: The results indicate that implementing care bundles reduced SSI incidence. However, because there was clinically important variation in the composition of and compliance with care bundles, additional research with standardized care bundles is needed to confirm this finding.

PMID:35723958 | DOI:10.1097/01.ASW.0000831080.51977.0b

J Biopharm Stat. 2022 Jun 20:1-17. doi: 10.1080/10543406.2022.2089155. Online ahead of print.

ABSTRACT

In early phase oncology drug development, single arm proof-of-concept (POC) studies are increasingly being used to drive the early decisions for future development of the drug. Decision-makings based on such studies, typically involving small sample size and early surrogate efficacy endpoints, are extremely challenging. In particular, given the tremendous competition in the development of immunotherapies, expedition of the most promising programs is desired. To this end, we have proposed a Bayesian three-tier approach to facilitate the decision-making process, inheriting all the benefits of Bayesian decision-making approaches and formally allowing the option of acceleration. With pre-specified Bayesian decision criteria, three types of decisions regarding the future development of the drug can be made: (1) terminating the program, (2) further investigation, considering totality of evidence or additional POC studies, and (3) accelerating the program. We further proposed a Bayesian adaptive three-tier (BAT) design, extending the decision-making approach to incorporate adaptive thresholds and allow for continuous monitoring of the study. We compare the performance of the proposed methods with some other existing methods through simulations.

PMID:35723946 | DOI:10.1080/10543406.2022.2089155

Retina. 2022 Jul 1;42(7):1338-1346. doi: 10.1097/IAE.0000000000003458.

ABSTRACT

PURPOSE: To assess retinal microvascular alterations in individuals with amnestic mild cognitive impairment (MCI) and nonamnestic MCI.

METHODS: One hundred twelve eyes of 59 amnestic MCI participants, 32 eyes of 17 nonamnestic MCI participants, and 111 eyes of 56 controls with normal cognition were included. Optical coherence tomography angiography vessel density and perfusion density in the Early Treatment Diabetic Retinopathy Study 3-mm circle and ring were assessed. Retinal thickness parameters including retinal nerve fiber layer thickness, ganglion cell-inner plexiform layer thickness, central subfield thickness, and subfoveal choroidal thickness were also analyzed. Multivariable generalized estimating equations were used for statistical analysis.

RESULTS: Perfusion density in the 3-mm inner ring was significantly lower in amnestic MCI patients when compared with nonamnestic MCI participants (0.29 ± 0.03 vs. 0.34 ± 0.09, P = 0.025) and controls with normal cognition (0.29 ± 0.03 vs. 0.39 ± 0.02, P < 0.001), after adjustment for age and sex as covariates. Vessel density, retinal nerve fiber layer thickness, ganglion cell-inner plexiform layer thickness, central subfield thickness, and subfoveal choroidal thickness did not differ among or between diagnostic groups.

CONCLUSION: Perfusion density was significantly reduced in individuals with amnestic MCI, compared with those with nonamnestic MCI and controls with normal cognition.

PMID:35723922 | DOI:10.1097/IAE.0000000000003458

Retina. 2022 Jul 1;42(7):1238-1247. doi: 10.1097/IAE.0000000000003452.

ABSTRACT

PURPOSE: To quantitatively evaluate the inner and outer choroidal changes in the fellow eyes of patients with unilateral central serous chorioretinopathy (CSC).

METHODS: We analyzed data from patients with a diagnosis of unilateral CSC who had structural optical coherence tomography (OCT) and swept-source OCT angiography obtained. An additional group of age-matched healthy patients was included for comparison. The main outcome measures were: (1) choriocapillaris flow deficits’ quantitative metrics; (2) choroidal luminal (LCA) and stromal (SCA) areas; and (3) choroidal vascularity index.

RESULTS: Fellow unaffected eyes from 60 patients with unilateral CSC and 30 healthy subjects were included in the analysis. Mean ± SD age was 47.5 ± 9.9 years in the unilateral CSC group and 50.7 ± 10.8 years in the control group (P = 0.410). In the structural OCT assessment, both the LCA and SCA were increased in the unilateral CSC group (0.33 ± 0.11 and 0.29 ± 0.10 mm2) compared with healthy controls (0.28 ± 0.08 and 0.27 ± 0.05 mm2), although only differences in LCA reached a statistical significance (P = 0.041 and P = 0.286 for LCA and SCA, respectively). The choroidal vascularity index was higher in CSC patients (53.7 ± 3.6 and 50.9 ± 5.5%, P = 0.045). In the OCT angiography evaluation, the choriocapillaris flow deficits’ percentage and number were increased in those patients affected by unilateral CSC. In multiple regressions, the strongest association with choriocapillaris percentage of flow deficits was with the presence of pachychoroid pigment epitheliopathy signs in the study eye (P < 0.0001).

CONCLUSION: Our results corroborate the hypothesis that inner and outer choroidal changes affect both eyes of patients with unilateral disease.

PMID:35723918 | DOI:10.1097/IAE.0000000000003452