Tag: pubmed

Surg Endosc. 2022 Jun 10. doi: 10.1007/s00464-022-09349-w. Online ahead of print.

ABSTRACT

BACKGROUND: Resident involvement in the operating room is a vital component of their medical education. Laparoscopic cholecystectomy (LC) represents the paradigmatic minimally invasive training procedure, both due to its prevalence and its different forms of complexity. We aim to evaluate whether the supervised participation of residents as operative surgeons in LC of different degrees of complexity affects postoperative outcomes in a university hospital.

METHODS: This is a retrospective, single-center study that included all consecutive adult (> 18 years old) patients operated for a LC between January 1, 2012 and December 31, 2017. Each surgical procedure was recorded according to the level of complexity that we established in three types of categorization (level 1: elective surgery; level 2: cholecystitis; level 3: biliary instrumentation). Patients were clinically monitored at an outpatient clinic 7 and 30-day postoperative. Postoperative outcomes of patients operated by supervised residents (SR) and trained surgeons (TS) were compared. Postoperative complications were graded according to the Clavien-Dindo classification of surgical complications.

RESULTS: A total of 2331 patients underwent LC during the study period, of whom 1573 patients (67.5%) were operated by SR and 758 patients (32.5%) by TS. There were no significant differences among age, sex, and BMI between patients operated in both groups, with the exception of ASA (P = 0.0001). Intraoperative cholangiography was performed in 100% of the patients, without bile duct injuries. There were no deaths in the 30 postoperative days. The overall complication rate was 5.70% (133 patients), with no significant differences when comparing LC performed by SR and TS (5.09 vs. 6.99%; P = 0.063). The severity rates of complications were similar in both groups (P = 0.379). Patient readmission showed a statistical difference comparing SR vs TS (0.76% vs. 2.2%; P = 0.010). The postoperative complications rate according to the complexity level of LC was not significant in level 1 and 2 for both groups. However in complexity level 3 the TS group experienced a greater rate of complications compared to the SR group (18.12% vs. 9.38%; P = 0.058). In the multivariate analysis, the participation of the residents as operating surgeons was not independently associated with an increased risk of complications (OR 1.22, 95% CI 0.84-1.77; P = 0.275), neither other risk factors like age ≥ 65 years, BMI, complexity level 2-3, or ASA ≥ 3-4. The association of another surgical procedure with the LC was an independent factor of morbidity (OR 3.85, 95% CI 2.54-5.85; P = 0.000).

CONCLUSION: Resident involvement in LC with different degrees of complexity did not affect postoperative outcomes. The participation of a resident as operating surgeon is not an independent risk factor and may be considered ethical, safe, and reliable whenever implemented in the background of a residency-training program with continuous supervision and national accreditation. The sum of other procedures not related to a LC should be taken as a risk factor of morbidity.

PMID:35687252 | DOI:10.1007/s00464-022-09349-w

Eur Child Adolesc Psychiatry. 2022 Jun 10. doi: 10.1007/s00787-022-01986-9. Online ahead of print.

ABSTRACT

The clinical validity of the distinction between ADHD and ASD is a longstanding discussion. Recent advances in the realm of data-driven analytic techniques now enable us to formally investigate theories aiming to explain the frequent co-occurrence of these neurodevelopmental conditions. In this study, we probe different theoretical positions by means of a pre-registered integrative approach of novel classification, subgrouping, and taxometric techniques in a representative sample (N = 434), and replicate the results in an independent sample (N = 219) of children (ADHD, ASD, and typically developing) aged 7-14 years. First, Random Forest Classification could predict diagnostic groups based on questionnaire data with limited accuracy-suggesting some remaining overlap in behavioral symptoms between them. Second, community detection identified four distinct groups, but none of them showed a symptom profile clearly related to either ADHD or ASD in neither the original sample nor the replication sample. Third, taxometric analyses showed evidence for a categorical distinction between ASD and typically developing children, a dimensional characterization of the difference between ADHD and typically developing children, and mixed results for the distinction between the diagnostic groups. We present a novel framework of cutting-edge statistical techniques which represent recent advances in both the models and the data used for research in psychiatric nosology. Our results suggest that ASD and ADHD cannot be unambiguously characterized as either two separate clinical entities or opposite ends of a spectrum, and highlight the need to study ADHD and ASD traits in tandem.

PMID:35687205 | DOI:10.1007/s00787-022-01986-9

AIDS Behav. 2022 Jun 10. doi: 10.1007/s10461-022-03736-z. Online ahead of print.

ABSTRACT

HPTN 069/ACTG 5305 was designed to evaluate potential new PrEP regimens that included maraviroc, tenofovir disoproxil fumarate, and/or emtricitabine. The current analyses assessed antiretroviral (ARV) plasma concentrations in relation to sexual behavior in 224 cisgender men who have sex with men and 2 transgender women at risk for HIV. Poisson generalized estimating equations (GEE) regression were used to test for associations between self-reported sexual behavior, sociodemographic, behavioral variables, and study drug levels The median (IQR) age was 30 [25, 37] years old; 48.2% had completed college; 27.4% were Black and 21.7% Latino. At weeks 24 and 48, one third of participants reported condomless anal sex (CAS) in the prior month with more than one partner. CAS was associated with daily ARV drug use (χ² = 12.64, p = 0.002). Older individuals and those with greater education were more likely to ingest ARV drugs daily (χ² = 9.36, p = 0.009 and χ² = 8.63, p = 0.013, respectively), while neither race nor ethnicity was associated with daily ARV drug use. Participants who reported recent condomless anal sex and/or advanced education had higher rates of daily ARV drug use. These data support the need for ongoing adherence counseling in clinical trials of new PrEP modalities.

PMID:35687192 | DOI:10.1007/s10461-022-03736-z

Eur Arch Otorhinolaryngol. 2022 Jun 10. doi: 10.1007/s00405-022-07449-w. Online ahead of print.

ABSTRACT

OBJECTIVE: This study is to compare the hearing outcomes and complications of stapes surgery and cochlear implantation (CI) in patients with far-advanced otosclerosis (FAO).

DATA SOURCES: A comprehensive electronic search of PubMed/MEDLINE, Scopus, Web of science and Cochrane Library was conducted in June 2021 for articles in the literature till this year.

STUDY SELECTION: Studies are published in English language, conducted on human subjects, concerned with comparison of CI and stapes surgery in the management of FAO, not Laboratory study and not Opinion study. The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA).

DATA EXTRACTION: Twenty-six studies were included with 334 patients in CI group and 241 patients in stapes surgery group. Comparison between both groups was done in terms of postoperative complications, audiological outcomes, rete of revision surgery and patients’ satisfaction rate.

RESULTS: Postoperative complications rate was significantly lower in CI (13.6%) than stapes surgery (18.6%). CI had a significantly lower rate of revision surgery (8.1%) than stapes surgery (16.4%). CI had a better mean for pure tone average (29.1 dB) than stapedectomy (52.3 dB) while stapes surgery had a higher mean for recognition of monosyllables and disyllables than CI. CI had significantly higher satisfaction rate than stapes surgery.

CONCLUSION: Both Stapes surgery and CI are reliable treatment options for FAO with close success rates. Statistics of CI are greater than stapes surgery and CI has a consistent improvement in audiometric outcomes in comparison to stapes surgery.

PMID:35687184 | DOI:10.1007/s00405-022-07449-w

Med Klin Intensivmed Notfmed. 2022 Jun 10. doi: 10.1007/s00063-022-00929-1. Online ahead of print.

ABSTRACT

BACKGROUND: Agency nursing is used as a form of labour to counter vacant staff positions in hospitals. Stakeholders and nurses might view this critically for different reasons.

AIM: The aim of this study was to evaluate what individual net income nurses in German intensive care units and intermediate care units consider “fair and acceptable” for their work. Furthermore, what influence does salary have on the willingness to change to agency nursing or back to a permanent position.

METHODS: From September-October 2020, an anonymous online survey was performed among nurses of intermediate care units, intensive care units and special care units in German-speaking countries. The results were evaluated using descriptive statistics.

RESULT: Of 1203 participants, 1036 (86%) of those working in Germany could be evaluated. The question about the individual net income was answered by 1032 (99%) participants. The majority of respondents (n = 522) stated that they had an individual net income of 2000-2999 €/month. The higher the level of the net income, the lower the willingness to switch to agency work. The participants in permanent employment only perceive a net income of 3200 €/month (median 3200 €; interquartile range [IQR] 2800-3800 €) as acceptable and fair for their work. In all, 142 agency nurses stated that an individual net income of 3200 €/month (median 3200 €; IQR 3000-3950 €) would be sufficient to move from agency nursing back into permanent employment.

CONCLUSION: The intensive care nurses in this survey consider a salary of 3200 €/month as acceptable and fair for their work. The salary level can be a parameter for the decision to go into agency work, but also to move back to permanent employment. Regardless of the salary, better working conditions were indicated as an essential element in terms of job satisfaction for all respondent groups.

PMID:35687181 | DOI:10.1007/s00063-022-00929-1

Knee Surg Sports Traumatol Arthrosc. 2022 Jun 10. doi: 10.1007/s00167-022-07022-2. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the thickness and intra-substance change of anterior capsule of the hip joint, and compare the difference of the capsular features in patients with different statuses of hip stability.

METHODS: A retrospective study was performed to review a hip preservation database. Using the lateral center edge angle(LCEA), patients with borderline dysplasia of the hip (BDH) of 20° ≤ LCEA ≤ 25°, femoracetabular impingement(FAI) with LCEA > 30° and dysplasia of the hip (DH) of LCEA < 20° were enrolled and stratified into different treatment groups. The patients’ imaging was reviewed by two experienced musculoskeletal radiologists who were blinded to clinical outcomes. Thickness and intra-substance change of the anterior hip capsule was measured on the sagittal oblique sequences of MRI. A surgeon measured the thickness of the anterior hip capsule during arthroscopy. The capsular thickness and intra-substance change were compared among different groups.

RESULTS: Thirty patients (17 women and 13 men) enrolled in each group (FAI, BDH, and DH) matched by sex and ages were evaluated. There were no significant differences in terms of age, sex, BMI, Alpha angle, and Tönnis grade among all three groups. The mean thickness of the anterior capsule in the DH group was 3.2 ± 0.5 mm, which was significantly thinner than that in the BDH and FAI groups (4.5 ± 0.8 mm and 4.7 ± 0.6 mm), and there was no significant difference in capsular thickness between the BDH and FAI groups. The Median of anterior capsule thickness via arthroscopic measuring was 6 mm and 7 mm in the BDH and FAI groups respectively, which has no statistical difference. The intra-substance change of the anterior capsule shows a significant difference among the three groups, and a higher incidence of delamination of the capsule was found in DH groups (p < 0.001).

CONCLUSIONS: Patients with hip dysplasia have a significantly reduced capsular thickness on MRI and delaminated anterior joint capsule, which could be a sequence of instability. The clinical relevance of this study is that capsular thickness and intra-substance changes of the anterior capsule vary which could alter capsular management strategies.

LEVEL OF EVIDENCE: Level III of evidence, DIAGNOSTIC STUDIES, No consistently applied reference standard.

PMID:35687148 | DOI:10.1007/s00167-022-07022-2

Graefes Arch Clin Exp Ophthalmol. 2022 Jun 10. doi: 10.1007/s00417-022-05721-7. Online ahead of print.

ABSTRACT

PURPOSE: Aim of this study was to evaluate the frequencies, trends, and antibiotic resistance of bacteria collected from ocular surface or contact lens material in a German tertiary referral center from 2009 to 2019.

METHODS: Microbiological data from 2009 to 2019 was analyzed. Culture-dependent microbial identification and analysis of antibiotic sensitivity was completed by the Institute of Microbiology. Statistical analysis of age- and sex-specific differences as well as changes in the microbial spectrum and resistance over the study period was performed with GraphPad Prism 9.0 applying nonparametric tests (level of significance: p ≦ 0.05).

RESULTS: A total of 6361 specimens were analyzed. Positivity rate was 18.6%. Sixty-three percent (n = 680) of the bacterial isolates were derived from ocular surface and 37% (n = 399) from contact lens material. The ratio of gram-negative bacteria was significantly higher in contact lens material. Multiresistant bacteria showed a significant increase with patient age (p < 0.0001). An overall increase in resistance to levofloxacin (p = 0.0239) was detected. Only 2.4% and 3.1% isolates were resistant to a combination of moxifloxacin and gentamicin, respectively, levofloxacin and gentamicin.

CONCLUSIONS: The reported bacterial spectrum is similar to comparable centers. Our data show that it should not be assumed that the newest classes of antibiotics have the best efficacy or lowest resistance levels. In suspected bacterial conjunctivitis, we propose using gentamicin as first-line therapy. In therapy refractive cases and in involvement of the cornea, we recommend a combination of gentamicin and ofloxacin or moxifloxacin. Overall, the evaluated organisms showed good sensitivity to the regularly used antibiotics.

PMID:35687174 | DOI:10.1007/s00417-022-05721-7

Am J Respir Crit Care Med. 2022 Jun 10. doi: 10.1164/rccm.202112-2745OC. Online ahead of print.

ABSTRACT

RATIONALE: The role of obesity-associated insulin resistance (IR) in airflow limitation in asthma is uncertain.

OBJECTIVES: Using data in the Severe Asthma Research Program 3 (SARP-3), we evaluated relationships between homeostatic measure of IR (HOMA-IR), lung function (cross sectional and longitudinal analyses) and treatment responses to bronchodilators and corticosteroids.

METHODS: HOMA-IR values was categorized as without (< 3.0), moderate (3.0-5.0), or severe (>5.0). Lung function included forced expired volume in one second (FEV1) and forced vital capacity (FVC) measured before and after treatment with inhaled albuterol and intramuscular triamcinolone acetonide (TA) and yearly for 5 years.

MEASUREMENTS AND MAIN RESULTS: Among 307 participants in SARP-3, 170 (55%) were obese and 140 (46%) had IR. Compared to patients without IR, those with IR had significantly lower values for forced expired volume in one second (FEV1) and forced vital capacity (FVC), and these lower values were not attributable to obesity effects. Compared to patients without IR, those with IR had lower FEV1 responses to beta adrenergic agonists and systemic corticosteroids. The annualized decline in FEV1 was significantly greater in patients with moderate IR (-41 mLs/year) and severe IR (-32 mLs/year,) than in patients without IR (-13mLs/year, p< 0.001 for both comparisons).

CONCLUSION: IR is common in asthma and is associated with lower lung function, accelerated loss of lung function, and suboptimal lung function responses to bronchodilator and corticosteroid treatments. Clinical trials in patients with asthma and IR are needed to determine if improving IR might also improve lung function.

PMID:35687105 | DOI:10.1164/rccm.202112-2745OC

Chin J Dent Res. 2022 Jun 10;25(2):131-137. doi: 10.3290/j.cjdr.b3086349.

ABSTRACT

OBJECTIVE: To investigate the relationship between chewing sugar-free gum (SFG) and dental caries status in China.

METHODS: A total of 860 teenagers (aged 12 to 15 years) and 490 adults (aged ≥ 18 years) were recruited using a multistage stratified cluster method from economically developed areas (Beijing, Guangdong) and less economically developed areas (Hubei, Xinjiang). Each participant completed a questionnaire including oral health-related knowledge of SFG and chewing habits of SFG and agreed to undertake a clinical assessment. Potential factors associated with chewing conditions were analysed through a chi-square statistical test. A negative binominal regression analysis was performed to quantify the relationship between dental caries and consumption of SFG.

RESULTS: The overall percentage of the survey population who consumed SFG was 43.4%, and SFG-related knowledge and awareness was only 19.4%. For decayed, missing and filled permanent teeth (DMFT), the mean value was 1.63 ± 2.41 and 2.29 ± 3.65 in the chewing group and non-chewing group, respectively. According to the negative binominal regression analysis, the caries status in the SFG chewing group was better than in the non-chewing group (adjusted prevalence rate ratio [PRR] 0.73; 95% confidence interval [CI] 0.62-0.87).

CONCLUSION: The chewing condition and oral health-related knowledge and awareness of SFG is low. Chewing SFG is related to a better dental caries status, so regular consumption of SFG should be recommended when promoting oral health.

PMID:35686593 | DOI:10.3290/j.cjdr.b3086349

Chin J Dent Res. 2022 Jun 10;25(2):125-130. doi: 10.3290/j.cjdr.b3086347.

ABSTRACT

OBJECTIVE: To evaluate the change in demineralisation depth (DD)and mineral density (MD) over time in primary teeth exposed to a demineralisation protocol with microcomputed tomography (microCT).

METHODS: Caries lesions were artificially induced on the labial surfaces of 9 primary incisors by way of a demineralisation protocol using 0.1 M lactic acid with 10% methylcellulose gel for 7 and 14 days. The specimens were scanned with microCT and CTAn software (Bruker, Billerica, MA, USA) was used to analyse the changes in DD and MD. Statistical analyses were performed using SPSS software (IBM, Armonk, NY, USA). Repeated analysis of variance (ANOVA) test and Pearson bivariate correlation were used and the level of significance was set at P < 0.05.

RESULTS: The DD ranged from 0.00 to 0.99 μm (mean ± standard deviation [SD] 0.70 ± 0.43 μm) at baseline, 11.18 to 29.5 μm (18.15 ± 5.23 μm) at 7 days and 18.00 to 55.30 μm (34.20 ± 8.70 μm) at 14 days. The MD for all specimens (n = 9) ranged from 1.48 to 1.76 g/cm3 (1.65 ± 0.08 g/cm3) at baseline, from 1.47 to 1.74 g/cm3 (1.62 ± 0.08 g/cm3) at 7 days demineralisation and 1.33 to 1.72 g/cm3 (1.54 ± 0.13 g/cm3) at 14 days. There were statistically significant differences in DD (P < 0.001) and MD (P = 0.016) between different durations of demineralisation.

CONCLUSION: DD and MD change with time after being exposed to demineralising solution. MicroCT is a nondestructive method that allows repeated MD evaluations of the same sample.

PMID:35686592 | DOI:10.3290/j.cjdr.b3086347