Tag: pubmed

Pediatrics. 2023 Jul 12:e2022059938. doi: 10.1542/peds.2022-059938. Online ahead of print.

ABSTRACT

OBJECTIVES: We sought to improve utilization of a sepsis care bundle and decrease 3- and 30- day sepsis-attributable mortality, as well as determine which care elements of a sepsis bundle are associated with improved outcomes.

METHODS: Children’s Hospital Association formed a QI collaborative to Improve Pediatric Sepsis Outcomes (IPSO) (January 2017-March 2020 analyzed here). IPSO Suspected Sepsis (ISS) patients were those without organ dysfunction where the provider “intended to treat” sepsis. IPSO Critical Sepsis (ICS) patients approximated those with septic shock. Process (bundle adherence), outcome (mortality), and balancing measures were quantified over time using statistical process control. An original bundle (recognition method, fluid bolus < 20 min, antibiotics < 60 min) was retrospectively compared with varying bundle time-points, including a modified evidence-based care bundle, (recognition method, fluid bolus < 60 min, antibiotics < 180 min). We compared outcomes using Pearson χ-square and Kruskal Wallis tests and adjusted analysis.

RESULTS: Reported are 24 518 ISS and 12 821 ICS cases from 40 children’s hospitals (January 2017-March 2020). Modified bundle compliance demonstrated special cause variation (40.1% to 45.8% in ISS; 52.3% to 57.4% in ICS). The ISS cohort’s 30-day, sepsis-attributable mortality dropped from 1.4% to 0.9%, a 35.7% relative reduction over time (P < .001). In the ICS cohort, compliance with the original bundle was not associated with a decrease in 30-day sepsis-attributable mortality, whereas compliance with the modified bundle decreased mortality from 4.75% to 2.4% (P < .01).

CONCLUSIONS: Timely treatment of pediatric sepsis is associated with reduced mortality. A time-liberalized care bundle was associated with greater mortality reductions.

PMID:37435672 | DOI:10.1542/peds.2022-059938

Psychol Med. 2023 Jul 12:1-10. doi: 10.1017/S0033291723001824. Online ahead of print.

ABSTRACT

BACKGROUND: Childhood trauma may impact the course of schizophrenia spectrum disorders (SSD), specifically in relation to the increased severity of depressive or negative symptoms. The type and impact of trauma may differ between sexes. In a large sample of recent-onset patients, we investigated the associations of depressive and negative symptoms with childhood trauma and whether these are sex-specific.

METHODS: A total of 187 first-episode psychosis patients in remission (Handling Antipsychotic Medication: Long-term Evaluation of Targeted Treatment study) and 115 recent-onset SSD patients (Simvastatin study) were included in this cross-sectional study (men: n = 218; women: n = 84). Total trauma score and trauma subtypes were assessed using the Childhood Trauma Questionnaire Short Form; depressive and negative symptoms were rated using the Positive And Negative Symptoms Scale. Sex-specific regression analyses were performed.

RESULTS: Women reported higher rates of sexual abuse than men (23.5% v. 7.8%). Depressive symptoms were associated with total trauma scores and emotional abuse ratings in men (β: 0.219-0.295; p ≤ 0.001). In women, depressive symptoms were associated with sexual abuse ratings (β: 0.271; p = 0.011). Negative symptoms were associated with total trauma score and emotional neglect ratings in men (β: 0.166-0.232; p ≤ 0.001). Negative symptoms in women were not linked to childhood trauma, potentially due to lack of statistical power.

CONCLUSIONS: Depressive symptom severity was associated with different types of trauma in men and women with recent-onset SSD. Specifically, in women, depressive symptom severity was associated with childhood sexual abuse, which was reported three times as often as in men. Our results emphasize the importance of sex-specific analyses in SSD research.

PMID:37435649 | DOI:10.1017/S0033291723001824

Palliat Support Care. 2023 Jul 12:1-8. doi: 10.1017/S1478951523000883. Online ahead of print.

ABSTRACT

BACKGROUND: Undergraduate nursing education prepares student for entry into the profession. Palliative care is an essential component of nursing education; however, a focus on the management of symptom burden fails to prepare the undergraduate in communication skills required for palliative or end-of-life care (EoLC). Simulation to teach acute care is well researched; however, limited studies explore simulation for palliative care or EoLC. Fewer studies combine communication with palliative care simulation.

OBJECTIVES: The overarching aim is to explore the influence of a palliative care communication simulation on undergraduate nursing students.

METHODS: Participants were students recruited from two campuses at a major Australian university in 2021. Students attended a compulsory simulation for all nursing or nursing and midwifery students. Pre- and post-simulation questionnaires collected qualitative and quantitative responses from participants. This paper reports that the quantitative data captured included demographic information, and the Frommelt Attitude Toward Care of the Dying (FATCOD-B) tool, to assess the attitudes. The qualitative component of the research will be reported as a separate paper.

RESULTS: A statistically significant increase in FATCOD-B scores was observed between pre- and post-simulation questionnaires, as well as a statistically significant difference related to the gender of participants. Age and previous experience with death also impacted FATCOD-B results.

SIGNIFICANCE OF RESULTS: The increase in FATCOD-B scores demonstrate that the positive impact of simulation suggests the importance of educational interventions such as the one conducted in this study. Education to improve the attitude toward caring for the dying and communication skills for difficult conversations are relevant and valuable. Further research is indicated.

PMID:37435646 | DOI:10.1017/S1478951523000883

J Magn Reson Imaging. 2023 Jul 12. doi: 10.1002/jmri.28899. Online ahead of print.

ABSTRACT

BACKGROUND: Conventional segmented, retrospectively gated cine (Conv-cine) is challenged in patients with breath-hold difficulties. Compressed sensing (CS) has shown values in cine imaging but generally requires long reconstruction time. Recent artificial intelligence (AI) has demonstrated potential in fast cine imaging.

PURPOSE: To compare CS-cine and AI-cine with Conv-cine in quantitative biventricular functions, image quality, and reconstruction time.

STUDY TYPE: Prospective human studies.

SUBJECTS: 70 patients (age, 39 ± 15 years, 54.3% male).

FIELD STRENGTH/SEQUENCE: 3T; balanced steady state free precession gradient echo sequences.

ASSESSMENT: Biventricular functional parameters of CS-, AI-, and Conv-cine were measured by two radiologists independently and compared. The scan and reconstruction time were recorded. Subjective scores of image quality were compared by three radiologists.

STATISTICAL TESTS: Paired t-test and two related-samples Wilcoxon sign test were used to compare biventricular functional parameters between CS-, AI-, and Conv-cine. Intraclass correlation coefficient (ICC), Bland-Altman analysis, and Kendall’s W method were applied to evaluate agreement of biventricular functional parameters and image quality of these three sequences. A P-value <0.05 was considered statistically significant, and standardized mean difference (SMD) < 0. 100 was considered no significant difference.

RESULTS: Compared to Conv-cine, no statistically significant differences were identified in CS- and AI-cine function results (all P > 0.05), except for very small differences in left ventricle end-diastole volumes of 2.5 mL (SMD = 0.082) and 4.1 mL (SMD = 0.096), respectively. Bland-Altman scatter plots revealed that biventricular function results were mostly distributed within the 95% confidence interval. All parameters had acceptable to excellent interobserver agreements (ICC: 0.748-0.989). Compared with Conv-cine (84 ± 13 sec), both CS (14 ± 2 sec) and AI (15 ± 2 sec) techniques reduced scan time. Compared with CS-cine (304 ± 17 sec), AI-cine (24 ± 4 sec) reduced reconstruction time. CS-cine demonstrated significantly lower quality scores than Conv-cine, while AI-cine demonstrated similar scores (P = 0.634).

CONCLUSION: CS- and AI-cine can achieve whole-heart cardiac cine imaging in a single breath-hold. Both CS- and AI-cine have the potential to supplement the gold standard Conv-cine in studying biventricular functions and benefit patients having difficulties with breath-holds.

LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 1.

PMID:37435633 | DOI:10.1002/jmri.28899

Otolaryngol Head Neck Surg. 2023 Jul 12. doi: 10.1002/ohn.417. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine if ultrasound-guided (USG) radiofrequency ablation (RFA) of Parotid Warthin’s tumor under local anesthesia is a safe and effective procedure.

STUDY DESIGN: Safety and feasibility study.

SETTING: Tertiary academic medical center.

METHODS: This is an IDEAL phase 2a trial in a tertiary referral center. Twenty patients with Parotid Warthin’s tumor were recruited. RFA was done between September and December 2021 for all 20 patients using a CoATherm AK-F200 machine with a disposable, 18G × 7 mm radiofrequency electrode. Results and follow-up statistics were compared with a historic sample of patients with parotid Warthin’s tumor who underwent parotidectomy between 2019 and 2021 in the same center.

RESULTS: Nineteen patients were included in the analysis as 1 patient dropped out after 4 weeks of follow-up. The mean age for the RFA group was 67 years old with most of them being male smokers. At a median of 45 weeks (44-47 weeks) postprocedure there was a 7.48 mL (68.4%) volume reduction compared to baseline. Three patients had transient facial nerve (FN) paresis, 1 recovered within hours, and the other 2 by 12 weeks follow-up. Three patients had great auricular nerve numbness; 1 patient had infected hematoma treated in an out-patient manner. Compared to a historic cohort of parotidectomy patients for Warthin’s tumor, there was no significant difference in FN paresis and other minor complications between the 2 treatment modalities.

CONCLUSION: The current analysis suggests that USG RFA of Warthin’s Tumor is a safe alternative to parotidectomy with shorter operative time and length of stay.

PMID:37435621 | DOI:10.1002/ohn.417

J Exerc Rehabil. 2023 Jun 28;19(3):163-169. doi: 10.12965/jer.2346170.085. eCollection 2023 Jun.

ABSTRACT

The talk test (TT) is subjective method to measure exercise intensity in costless and feasible manner, compared to sophisticated laboratory equipment. We attempted to investigate whether the TT was a valid method for evaluation of exercise intensity, by comparing with values derived from various physiologic markers during cardiopulmonary exercise testing on treadmill in healthy population. A total of 17 healthy subjects (12 males and 5 females) participated in this study. The TT was applied, which consisted of 3-stages difficulties demanding respiratory load while they performed the cardiopulmonary exercise testing on treadmill. In each of the TT stages, ergospirometric and psychophysiologic response marker were collected such as heart rate, oxygen consumption, respiratory exchange ratio, minute ventilation, carbon dioxide output, tidal volume, respiratory rate, and rating of perceived exertion of breathing. Statistical analyses revealed a significant difference of all dependent variables in each of three TT stages, comparing with the resting phase before the TT. The TT showed strong correlation coefficient with all variables except for rating of perceived exertion during the resting phase before the TT. According to increase of exercise intensity, all dependent variables showed a linear tendency with the stages of the TT. Our findings indicated that each of the TT stages was strongly correlated with ergospirometric variables as well as psychophysiologic response during cardiopulmonary exercise testing on treadmill. We suggested that the TT can be used to evaluate and prescribe exercise intensity of aerobic activity in cardiovascular and pulmonary rehabilitation settings.

PMID:37435593 | PMC:PMC10331140 | DOI:10.12965/jer.2346170.085

Orthop J Sports Med. 2023 Jun 1;11(6):23259671231160296. doi: 10.1177/23259671231160296. eCollection 2023 Jun.

ABSTRACT

BACKGROUND: Graft failure after meniscal allograft transplantation (MAT) may necessitate revision surgery or conversion to arthroplasty. A comprehensive understanding of the risk factors for failure after MAT of the knee may facilitate more informed shared decision-making discussions before surgery and help determine whether MAT should be performed based on patient risk.

PURPOSE: To perform a systematic review and meta-analysis of risk factors associated with graft failure after MAT of the knee.

STUDY DESIGN: Systematic review; Level of evidence, 4.

METHODS: The PubMed, OVID/Medline, and Cochrane databases were queried in October 2021. Data pertaining to study characteristics and risk factors associated with failure after MAT were recorded. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and MAT graft failure by generating effect estimates in the form of odds ratios (ORs) with 95% CIs. Qualitative analysis was performed to describe risk factors that were variably reported.

RESULTS: In total, 17 studies including 2184 patients were included. The overall pooled prevalence of failure at the latest follow-up was 17.8% (range, 3.3%-81.0%). In 10 studies reporting 5-year failure rates, the pooled prevalence of failure was 10.9% (range, 4.7%-23%). In 4 studies reporting 10-year failure rates, the pooled prevalence was 22.7% (range, 8.1%-55.0%). A total of 39 risk factors were identified, although raw data presented in a manner amenable to meta-analysis only allowed for 3 to be explored quantitatively. There was strong evidence to support that an International Cartilage Regeneration & Joint Preservation Society grade >3a (OR, 5.32; 95% CI, 2.75-10.31; P < .001) was a significant risk factor for failure after MAT. There was no statistically significant evidence to incontrovertibly support that patient sex (OR, 2.16; 95% CI, 0.83-5.64; P = .12) or MAT laterality (OR, 1.11; 95% CI, 0.38-3.28; P = .85) was associated with increased risk of failure after MAT.

CONCLUSION: Based on the studies reviewed, there was strong evidence to suggest that degree of cartilage damage at the time of MAT is associated with graft failure; however, the evidence was inconclusive on whether laterality or patient sex is associated with graft failure.

PMID:37435586 | PMC:PMC10331783 | DOI:10.1177/23259671231160296

SAGE Open Nurs. 2023 Jul 5;9:23779608231185922. doi: 10.1177/23779608231185922. eCollection 2023 Jan-Dec.

ABSTRACT

INTRODUCTION: A colostomy is a surgical procedure that brings one end of the large intestine out through the abdominal wall. Approximately 100,000 people in incidence in the United States undergo operations that result in a colostomy or ileostomy each year.

OBJECTIVE: To assess knowledge and associated factors toward colostomy care among staff Nurses working at Dessie Town governmental hospitals, Ethiopia 2022.

METHODS: Institutional-based cross-sectional study design was conducted at governmental hospitals in Dessie Town from August 1, 2022 to August 25, 2022. A simple random sampling technique was deployed using a self-administered questionnaire. Descriptive statistics analyses such as frequencies, percentage, and mean were used to summarize the results. Both bivariable and multivariable logistic regressions were employed to identify factors associated with participants’ knowledge of colostomy care. A p-value of <.05 and 95% confidence interval (CI) was used to declare statistical significance.

RESULTS: A total of 265 nurses participated making a response rate of 98.1%. About 57.6% (157) of the participants had good knowledge of providing colostomy care. Having a clinical experience of 4-6 years (adjusted odds ratio [AOR] = 2.4 95% CI: 1.186, 5.513), 6-8 years (AOR = 2.5, 95% CI: 1.981, 6.177), and >8 years (AOR = 3.3, 95% CI: 1.481, 7.394), providing colostomy care for 6-10 patients (AOR = 2.6, 95% CI: 1.186, 5.512) and 10 or more patients (AOR = 3.3, 95% CI: 1.480, 7.394), and routine reading of professional (AOR = 1.83, 95% CI: 1.062, 3.153) were significantly associated with good knowledge of colostomy care.

CONCLUSION AND RECOMMENDATION: Knowledge of colostomy care was not satisfactory among nurse professionals working in governmental hospitals in Dessie town. Participation in the training of colostomy care, having more than eight years of experience, providing colostomy care for more than seven patients, attending scientific colostomy meetings, and reading professional literature were significant factors associated with good knowledge of providing colostomy care. Thus, capacity-building in-service training is required to enhance the knowledge of colostomy care.

PMID:37435579 | PMC:PMC10331234 | DOI:10.1177/23779608231185922

TH Open. 2023 Jul 10;7(3):e195-e205. doi: 10.1055/s-0043-1770782. eCollection 2023 Jul.

ABSTRACT

Background Intracerebral hemorrhage is the most serious complication of anticoagulant therapy but the effects of different types of oral anticoagulants on the expansion of these hemorrhages are still unclear. Clinical studies have revealed controversial results; more robust and long-term clinical evaluations are necessary to define their outcomes. An alternative is to test the effect of these drugs in experimental models of intracerebral bleeding induced in animals. Aims To test new oral anticoagulants (dabigatran etexilate, rivaroxaban, and apixaban) in an experimental model of intracerebral hemorrhage induced by collagenase injection into the brain striatum of rats. Warfarin was used for comparison. Methods Ex vivo anticoagulant assays and an experimental model of venous thrombosis were employed to determine the doses and periods of time required for the anticoagulants to achieve their maximum effects. Subsequently, volumes of brain hematoma were evaluated after administration of the anticoagulants, using these same parameters. Volumes of brain hematoma were evaluated by magnetic resonance imaging, H&E (hematoxylin and eosin) staining, and Evans blue extravasation. Neuromotor function was assessed by the elevated body swing test. Results and Conclusions The new oral anticoagulants did not increase intracranial bleeding compared with control animals, while warfarin markedly favored expansion of the hematomas, as revealed by magnetic resonance imaging and H&E staining. Dabigatran etexilate caused a modest but statistically significant increase in Evans blue extravasation. We did not observe significant differences in elevated body swing tests among the experimental groups. The new oral anticoagulants may provide a better control over a brain hemorrhage than warfarin.

PMID:37435564 | PMC:PMC10332909 | DOI:10.1055/s-0043-1770782

Psychogeriatrics. 2023 Jul 11. doi: 10.1111/psyg.13000. Online ahead of print.

ABSTRACT

BACKGROUND: Because of physiological changes in geriatric patients, their surgical process differs from that of young adults. In this regard, the perioperative period is an extremely risky time for geriatric patients. The present study examined preoperative fear, anxiety, and perceived stress levels as well as the factors affecting them in elderly patients prior to surgical intervention.

METHODS: This study adopted a cross-sectional descriptive design. The study sample consisted of geriatric patients (n = 407) scheduled for elective laparoscopic cholecystectomy in a research and training hospital in northeast Turkey. Data were collected by the researchers using the personal information form, Perceived Stress Scale (PSS-10), Surgical Fear Questionnaire (SFQ) and Anxiety Specific to Surgery Questionnaire (ASSQ). In the data analysis, descriptive statistics, the t-test in independent groups, one-way analysis of variance (ANOVA), correlation analysis and Bonferroni tests for post hoc analyses were used.

RESULTS: On the PSS-10, the mean score was higher for the 75-and-older age group, single patients, patients with a disease requiring medication, and those who had previously undergone surgery (P < 0.05). On the ASSQ, the mean score was lower for patients aged 65-69, university graduates, patients without children, and those without a disease requiring medication (P < 0.05). On the SFQ, the mean score was higher for the 75-and-older age group, primary school graduates, and single patients (P < 0.05).

CONCLUSION: It was determined that being single, having a chronic disability, and advancing age had an effect on the patients’ surgery-specific anxiety, perceived stress, and fear of surgery. Long-standing chronic diseases can negatively affect both stress and anxiety levels of individuals.

PMID:37433670 | DOI:10.1111/psyg.13000