Tag: pubmed

BMC Med Educ. 2023 May 6;23(1):316. doi: 10.1186/s12909-023-04286-1.

ABSTRACT

BACKGROUND: Selecting an empiric antimicrobial regimen can be difficult for early learners and misuse of antibiotics can lead to adverse events and antimicrobial resistance. There have been few interventions that have focused on improving antibiotic decision making, as a form of therapeutic reasoning, for post-graduate trainees. We describe here an approach to aid internal medicine interns in their therapeutic reasoning, particularly when it comes to diagnosing and empirically treating infections.

METHODS: The PEST (pathology, epidemiology, severity, treatment) model was created as a four-step approach to therapeutic reasoning and choosing an appropriate antimicrobial regimen for a given infectious disease syndrome. In February 2020, we conducted two independent teaching sessions for interns on the PEST approach. We assessed pre-and post-teaching responses to five clinical vignette-based questions. Results were presented as a percentage of interns who chose an appropriate antibiotic and provided sufficient therapeutic reasoning as defined by using at least three out of the four PEST criteria. Statistical analysis occurred via Fischer’s exact test to determine the level of statistical significance between responses.

RESULTS: Twenty-seven interns participated in the activity. At baseline, several interns had incorporated aspects of the PEST approach in their pre-teaching responses. Ten interns commented on the usefulness of such a systematic approach. While there was no statistically significant difference in antibiotic selection, the teaching session demonstrated a trend towards significance in improving therapeutic reasoning as defined by the PEST strategy.

CONCLUSION: Our results suggested an improvement in using a structured cognitive tool such as the PEST approach to reinforce therapeutic reasoning, but the method did little to improve antibiotic selection. Some interns used select “PEST” concepts prior to the intervention suggesting that the PEST approach may enhance prior knowledge or clinical reasoning skills. Continued incorporation of the PEST approach using a case-based framework may solidify conceptual and practical knowledge of antimicrobial selection. Further studies are needed to assess the impact of such teaching interventions.

PMID:37149569 | DOI:10.1186/s12909-023-04286-1

BMC Surg. 2023 May 6;23(1):112. doi: 10.1186/s12893-023-01999-4.

ABSTRACT

OBJECTIVE: The management of paravebous sinus meningiomas that invade major venous sinuses is a subject of debate, particularly concerning the necessity of complete resection of the tumor and reconstruction of the venous sinus. This article aims to demonstrate the outcomes of total removal of the lesion (including the invading venous sinus portion) and the effects of restoring or not restoring venous circulation in terms of recurrence of the tumor, mortality, and post-operative complications.

METHODS: The authors conducted a study involving 68 patients with paravebous sinus meningiomas. Of the 60 parasagittal meningiomas, 23 were located in the anterior third, 30 in the middle third, and 7 in the posterior third. Additionally, 3 lesions were located in the sinus confluence area, and 5 in the transverse sinus. All patients underwent surgery, and the degree of venous sinus involvement was classified into six types. For type I meningiomas, the outer layer of the sinus wall was stripped off. For types II to VI, two strategies were employed: non-constitutional, wherein the tumor and affected venous sinuses were removed without repair, and reconstructive, wherein the tumor was completely removed and the venous sinuses were sutured or repaired. Karnofsky Performance Status (KPS) scale and Magnetic Resonance Venography (MRV) were utilized to assess the outcomes of the surgical procedures.

RESULTS: The study group of 68 patients underwent complete tumor resection in 97.1%, with sinus reconstruction attempted in 84.4% of cases with sinus wall and sinus cavity invasion. The recurrence rate of this group was 5.9%, with follow-up ranging from 33 to 57 months. It was found that the recurrence rate was significantly higher in cases with incomplete resection than in those with complete resection. The overall mortality rate was 4.4%, with all cases resulting from malignant brain swelling due to the failure to perform venous reconstruction after resectioning of the meningioma type VI. Furthermore, 10.3% of patients experienced worsening symptoms of neurological deficits or complete loss of neurological function, with a significantly higher incidence in those without venous reconstruction than in the venous reconstruction group (P < 0.0001, Fisher test). No statistically significant pre-operative and post-operative KPS differences were observed in patients with type I to V. However, in patients with type VI (who did not receive venous reconstruction), the post-operative KPS score was significantly worse.

CONCLUSION: The results of this study suggest the necessity of a complete resection of the tumor, including the invasive venous sinus component, as the recurrence rate was found to be relatively low at 5.9%. Moreover, patients who did not undergo venous reconstruction showed significant deterioration in their clinical condition compared to other subgroups, thus highlighting the importance of venous sinus reconstruction.

PMID:37149562 | DOI:10.1186/s12893-023-01999-4

J Comp Physiol B. 2023 May 7. doi: 10.1007/s00360-023-01490-9. Online ahead of print.

ABSTRACT

The gill oxygen limitation hypothesis (GOLH) suggests that hypometric scaling of metabolic rate in fishes is a consequence of oxygen supply constraints imposed by the mismatched growth rates of gill surface area (a two-dimensional surface) and body mass (a three-dimensional volume). GOLH may, therefore, explain the size-dependent spatial distribution of fish in temperature- and oxygen-variable environments through size-dependent respiratory capacity, but this question is unstudied. We tested GOLH in the tidepool sculpin, Oligocottus maculosus, a species in which body mass decreases with increasing temperature- and oxygen-variability in the intertidal, a pattern consistent with GOLH. We statistically evaluated support for GOLH versus distributed control of [Formula: see text] allometry by comparing scaling coefficients for gill surface area, standard and maximum [Formula: see text] ([Formula: see text]_,Standard and [Formula: see text]_,Max, respectively), ventricle mass, hematocrit, and metabolic enzyme activities in white muscle. To empirically evaluate whether there is a proximate constraint on oxygen supply capacity with increasing body mass, we measured [Formula: see text]_,Max across a range of Po₂s from normoxia to P_crit, calculated the regulation value (R), a measure of oxyregulatory capacity, and analyzed the R-body mass relationship. In contrast with GOLH, gill surface area scaling either matched or was more than sufficient to meet [Formula: see text] demands with increasing body mass and R did not change with body mass. Ventricle mass (b = 1.22) scaled similarly to [Formula: see text]_,Max (b = 1.18) suggesting a possible role for the heart in the scaling of [Formula: see text]_,Max. Together our results do not support GOLH as a mechanism structuring the distribution of O. maculosus and suggest distributed control of oxyregulatory capacity.

PMID:37149515 | DOI:10.1007/s00360-023-01490-9

Lifetime Data Anal. 2023 May 7. doi: 10.1007/s10985-023-09598-4. Online ahead of print.

ABSTRACT

Clustered and multivariate failure time data are commonly encountered in biomedical studies and a marginal regression approach is often employed to identify the potential risk factors of a failure. We consider a semiparametric marginal Cox proportional hazards model for right-censored survival data with potential correlation. We propose to use a quadratic inference function method based on the generalized method of moments to obtain the optimal hazard ratio estimators. The inverse of the working correlation matrix is represented by the linear combination of basis matrices in the context of the estimating equation. We investigate the asymptotic properties of the regression estimators from the proposed method. The optimality of the hazard ratio estimators is discussed. Our simulation study shows that the estimator from the quadratic inference approach is more efficient than those from existing estimating equation methods whether the working correlation structure is correctly specified or not. Finally, we apply the model and the proposed estimation method to analyze a study of tooth loss and have uncovered new insights that were previously inaccessible using existing methods.

PMID:37149514 | DOI:10.1007/s10985-023-09598-4

Women Birth. 2023 May 4:S1871-5192(23)00070-7. doi: 10.1016/j.wombi.2023.04.004. Online ahead of print.

ABSTRACT

PROBLEM: Papua New Guinea (PNG) has a high rate of preventable maternal and neonatal deaths.

BACKGROUND: Developing midwifery leadership is vital to addressing the current deficits in health outcomes for women and their babies. The PNG Midwifery Leadership Buddy Program responds to this need through leadership training and partnering of midwives across PNG and Australia. Participants in the program undertake a workshop in Port Moresby and commit to a 12-month peer support relationship with a midwife ‘buddy’.

AIM: To evaluate participants’ experiences of the Buddy Program and the impact of the program on leadership skills.

METHODS: All 23 midwives who had completed the program were invited to participate in the evaluation. The study used a concurrent mixed methods approach. Qualitative data were collected via interviews and then thematically analysed. Quantitative data were collected via a survey and analysed with descriptive statistics, then findings were triangulated.

FINDINGS: Participants reported increased confidence for leadership, action and advocacy. Numerous quality improvement projects were implemented in health services in PNG. Challenges to the success of the program included technological limitations, cultural differences and the COVID-19 pandemic.

DISCUSSION: Participants reported the PNG Midwifery Leadership Buddy Program was successful in increasing their leadership skills and collaborative opportunities, as well as strengthening midwifery more broadly. While there were barriers, most participants valued the experience and believed it benefited them professionally and personally CONCLUSION: The Buddy Program provides a practical model for building midwifery leadership capacity that may be transferrable to other contexts.

PMID:37149495 | DOI:10.1016/j.wombi.2023.04.004

Cancer Med. 2023 May 6. doi: 10.1002/cam4.5884. Online ahead of print.

ABSTRACT

BACKGROUND: We examined patient-level factors (patient characteristics, disease and treatment factors, and patient experience), patient-centered communication (PCCM), and non-adherence to adjuvant chemotherapy (AC) guidelines among breast and colon cancer patients to inform AC adherence promotion and improve clinical outcomes.

METHODS: Descriptive statistics for patient-level factors, PCCM, and AC non-adherence (primary non-adherence, non-persistence at 3 and 6 months) were obtained. Multiple logistic regression models were used to estimate AC non-adherence after accounting for the identified patient-level factors.

RESULTS: The majority of the sample (n = 577) were White (87%), breast cancer patients (87%), and reported PCCM (provider communication score ≥ 90%, 73%, provider communication score = 100%, 58%). All three levels of AC nonadherence were significantly higher in breast cancer patients (69%, 81%, and 89% for primary non-adherence, and non-persistence at 3 and 6 months, respectively) than colon cancer patients (43%, 46%, and 62%, respectively). Male sex, survey assistance, and low/average ratings of a personal doctor, specialist, and healthcare were associated with lower PCCM. Older age, breast cancer diagnosis, and diagnosis group following 2007-2009 increased the likelihood of all three levels of AC non-adherence. Comorbidities and PCCM-90 were exclusively associated with non-persistence at 3 months.

CONCLUSIONS: Adjuvant chemotherapy non-adherence varied by cancer diagnosis and treatment factors. The relationship between PCCM and AC non-adherence differed by level of PCCM, time period, and the presence of comorbidities. AC guideline adherence, communication, and value-concordant treatment should be assessed and compared simultaneously to improve our understanding of their interrelationships.

PMID:37148551 | DOI:10.1002/cam4.5884

Cancer Med. 2023 May 6. doi: 10.1002/cam4.6009. Online ahead of print.

ABSTRACT

BACKGROUND: Mantle cell lymphoma (MCL) is an uncommon heterogeneous subtype of B cell non-Hodgkin lymphoma, and clinical features in MCL appear regional characteristics. MCL treatment opinions are not uniform between countries or regions within Asia and China, and Asian patient-specific data for MCL treatment are fewer. The study aims to explore the clinical characteristics, treatment patterns and prognosis of MCL patients in China.

METHODS: A total of 805 patients diagnosed with MCL between April 1999 and December 2019 at 19 comprehensive hospitals in China were included in this retrospective analysis. Kaplan-Meier method coupled with the log-rank test was used for univariate analysis, and COX proportional hazards model was used for multivariate analysis (MVA). p < 0.05 was consided statistically significant. All outputs were produced using R version 4.1.0.

RESULTS: The median age of the cohort was 60.0 years with a male-to-female ratio of 3.36:1. Five-year progression-free survival (PFS) and overall survival (OS) rates were 30.9% and 65.0%, respectively. High-intermediate/high-risk group according to MIPI-c, without high-dose cytarabine, lack of Auto-SCT as consolidation and maintenance treatment and SD/PD in initial treatment remained statistically relevant to poor PFS on MVA, and ki67 ≥50%, B symptoms, high-intermediate/high risk group according to MIPI-c, without high-dose cytarabine, lack of maintenance treatment, SD/PD in initial treatment and relapse/refractory state were independently associated with poorer OS on MVA.

CONCLUSIONS: First-line high dose cytarabine exposure, auto-SCT as consolidation therapy obtained survival benefits in Chinese population. Our study further confirmed the value of maintenance treatment and explored the application of new drug treatment and bendamustine in R/R MCL patients.

PMID:37148540 | DOI:10.1002/cam4.6009

Cancer Med. 2023 May 6. doi: 10.1002/cam4.5974. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Leisure sedentary behavior (LSB) is associated with the risk of cancer, but the causal relationship between them has not been clarified. The aim of this study was to assess the potential causal association between LSB and risk of 15 site-specific cancers.

METHODS: The causal association between LSB and cancer were assessed with univariate Mendelian randomization (UVMR) and multivariate Mendelian randomization (MVMR). 194 SNPs associated with LSB (from the UK Biobank 408,815 individuals) were adopted as the instrument variables. Sensitivity analyses were performed to ensure the robustness of the results.

RESULTS: UVMR analysis revealed that television watching significantly increased the risk of endometrial cancer (OR = 1.29, 95% CI = 1.02-1.64, p = 0.04) (mainly the endometrioid histology [OR = 1.28, 95% CI = 1.02-1.60, p = 0.031])，breast cancer (OR = 1.16, 95% CI = 1.04-1.30, p = 0.007) (both ER+ breast cancer [OR = 1.17, 95% CI = 1.03-1.33, p = 0.015], and ER- breast cancer [OR = 1.55, 95% CI = 1.26-1.89, p = 2.23 × 10^-5 ]). Although causal association was not found between television watching and ovarian cancer, it was seen in low grade and low malignant potential serous ovarian cancer (OR = 1.49, 95% CI = 1.07-2.08, p = 0.018). However, significant results were not obtained in the UVMR analysis between driving, computer use and the 15 types of cancer. Further MVMR analysis indicated that the above results are independent from most metabolic factors and dietary habits, but mediated by educational attainment.

CONCLUSION: LSB in form of television watching has independent causal association with the risk of endometrial cancer, breast cancer, and ovarian cancer.

PMID:37148539 | DOI:10.1002/cam4.5974

Environ Sci Pollut Res Int. 2023 May 6. doi: 10.1007/s11356-023-27242-4. Online ahead of print.

ABSTRACT

Twenty-nine sediment samples were collected from the Hurghada Bay, a heavily polluted bay on the Red Sea of Egypt, to inspect the environmental quality status and anthropogenic consequences on benthic foraminifera. Some foraminiferal species showed deformations in their apertures and coiling directions as a response to environmental stresses. In addition, the FoRAM index, an index used for evaluating the growth of coral reefs, indicated a hazard in the proximity of nearshore stations. To elucidate the relationships between the biological response and chemistry of sediments, eight heavy metals concentrations (Cu, Cd, Zn, Pb, As, Cr, Ni, and Mn) were analyzed using inductively coupled plasma-atomic emission spectrometers (ICP-AES). Interestingly, two groups of benthic foraminiferal associations were illustrated using multivariate statistical analyses. Group I have extremely high heavy metal concentrations, an enriched total organic matter (TOM)%, high deformation percentages, and mud content. Moreover, it is dominated by Ammonia tepida which is regarded as an opportunistic species. Group II includes low to moderately polluted stations, highly enriched living foraminiferal assemblages, and is dominated by the sensitive rotaliids Neorotalia calcar and Amphistegina lobifera. Alternatively, four geochemical indices, EF, CF, I_geo, and PLI, are used to assess the contamination level that shown ominous spots for the nearshore stations of the Hurghada Bay. The pollution indices (HQ and HI) were also conducted to evaluate the risks of carcinogenic heavy metals on human health. Our findings demonstrated that ingestion and dermal exposure have greater carcinogenic hazards for adults and children than inhalation. The lifetime carcinogenic risk (LCR) is significantly higher than the permissible limit and follows this order: Pb > As > Cr > Cd > Ni. To that end, developing strategies to lessen the negative impact of pollution on human health and/or the Red Sea’s biodiversity is an inevitable issue in the present day and future.

PMID:37148519 | DOI:10.1007/s11356-023-27242-4

Environ Sci Pollut Res Int. 2023 May 6. doi: 10.1007/s11356-023-27434-y. Online ahead of print.

ABSTRACT

In this paper, we empirically study the spatial association network of PM_2.5 and the factors influencing those correlations using the gravity model, social network analysis (SNA), and the quadratic assignment procedure (QAP) based on data from the Beijing-Tianjin-Hebei urban agglomeration (BTHUA) in China from 2005 to 2018. We draw the following conclusions. First, the spatial association network of PM_2.5 exhibits relatively typical network structure characteristics: the network density and network correlations are highly sensitive to efforts to control air pollution, and there are obvious spatial correlations within the network. Second, cities in the center of the BTHUA have large network centrality values, while cities in the peripheral region have small centrality values. Tianjin is a core city in the network, and the spillover effect of PM_2.5 pollution in Shijiazhuang and Hengshui is the most noticeable. Third, the 14 cities can be divided into four plates, with each plate having obvious geographical location characteristics and linkage effects. The cities in the association network are divided into three tiers. Beijing, Tianjin, and Shijiazhuang are located in the first tier, and a considerable number of PM_2.5 connections are completed through these cities. Fourth, differences in geographical distance and urbanization are the main drivers of the spatial correlations of PM_2.5. The greater the urbanization differences, the more likely the generation of PM_2.5 links is, while the opposite is true for differences in geographical distance.

PMID:37148508 | DOI:10.1007/s11356-023-27434-y