Tag: pubmed

Braz Oral Res. 2022 Nov 11;36:e0126. doi: 10.1590/1807-3107bor-2022.vol36.0126. eCollection 2022.

ABSTRACT

The aim of this study was to evaluate the awareness of patients using bisphosphonates (BP) regarding their risks and benefits. Sixty-five patients using BP were included. Each participant completed a self-administered questionnaire consisting of 13 questions, including sociodemographic and general information on BP. Data were analyzed using descriptive statistics, and a binomial test was used to assess patient knowledge about BP, considering a 5% significance level. Fifty-nine (90.2%) patients were unaware or had never heard of BP drugs and only 3 (4.6%) knew their indications. Only 6 patients (9.2%) said they knew about the oral complications caused by BP. Sixty-three patients (96.9%) said they were not referred to the dentist before starting BP treatment. Patients using BP do not have satisfactory knowledge regarding the risks and benefits of BP. Physicians and dentists must be prepared to inform and counsel BP users about their adverse effects and possible risk factors. Our results emphasize the importance of public policies, whether individual or collective, to be taken to increase knowledge about BP to avoid medication-related osteonecrosis of the jaw.

PMID:36383832 | DOI:10.1590/1807-3107bor-2022.vol36.0126

Rev Gaucha Enferm. 2022 Nov 14;43(spe):e20220117. doi: 10.1590/1983-1447.2022.20220117.en. eCollection 2022.

ABSTRACT

OBJECTIVE: To describe and compare the physiological signs presented by premature infants in traditional and humanized weighing.

METHOD: A quasi-experimental crossover study, with a sample of 30 premature infants randomly assigned and allocated to the control group (traditional) and the intervention group (humanized), from March 2019 to March 2020, with the collection of general data, vital signs before and after the procedures. Statistical analyses included description of relative and absolute frequencies, measure of central tendency and dispersion.

RESULTS: Premature infants showed less increase in heart rate (53.3%) and respiratory rate (43%) in the verification of humanized weighing than in the traditional way, with 83.3% of neonates and 80%, respectively.

CONCLUSION: It was observed that the humanized form provided less physiological instability, especially in heart and respiratory rates, making it necessary to encourage discussions about the humanization of care and perform this practice routinely in health units.

PMID:36383829 | DOI:10.1590/1983-1447.2022.20220117.en

Rev Gaucha Enferm. 2022 Nov 14;43(spe):e20210288. doi: 10.1590/1983-1447.2022.20210288.en. eCollection 2022.

ABSTRACT

OBJECTIVE: To analyze the effect of the Patient-Centered Care model on the satisfaction of health professionals, nurses, speech therapists or dentists, who care for hospitalized adults.

METHOD: Systematic Review conducted from October/2020 to March/2021 at PubMed/Medline, CINAHL, EMBASE, SCOPUS, Web of Science and LILACS databases. Observational and interventional studies were included, relating the effect of Patient-Centered Care on the satisfaction of professionals. The Cochrane Collaboration Tool and Meta-Analysis of Statistics Assessment and Review Instrument tools assessed the methodological quality of the studies.

RESULTS: The effect of patient-centered care on job satisfaction was not identified in speech therapists or dentists. Nine selected articles relate it to nurses. Predictors of satisfaction pointed to factors related to interpersonal relationships, patient care and work organization.

CONCLUSION: The Patient-Centered Care model can be a facilitating strategy for nurses’ job satisfaction. However, the current scientific literature still needs further studies to strengthen existing evidence.

PMID:36383823 | DOI:10.1590/1983-1447.2022.20210288.en

Rev Paul Pediatr. 2022 Nov 14;41:e2021352. doi: 10.1590/1984-0462/2023/41/2021352. eCollection 2022.

ABSTRACT

OBJECTIVE: To evaluate the correlation between burden and sleep quality in caregivers of infants with cleft lip and/or palate.

METHODS: This descriptive cross-sectional study was carried out in a Brazilian tertiary public hospital between March and September 2020. The sample included the main informal, literate caregivers of infants with cleft lip and/or palate, aged 18 years or older. The instruments used were the Burden Interview Scale and the Pittsburgh Sleep Quality Index. Data were collected during the infants’ hospitalization. Statistical analysis adopted Pearson and Spearman correlations, with a 5% significance level.

RESULTS: A total of 31 informal caregivers participated in the study, most of them mothers (n=28; 90%), with a mean age of 30 years (standard deviation – SD=7.5), low socioeconomic status (n=20; 64%), who completed high school (n=19; 61%), were married (58%), had two children (n=15; 48%), and no employment relationship (n=18; 58%). A moderate correlation was found between sleep quality and burden (r=0.39; p=0.032) and between burden and subjective sleep quality (r=0.39; p=0.029), sleep latency (r=0.43; p=0.017), and daytime dysfunction (r=0.49; p<0.001).

CONCLUSIONS: The study showed that the higher the burden, the lower the sleep quality. The findings indicate the need to plan and implement interventions to minimize the burden experienced by these informal caregivers in order to improve their sleep quality.

PMID:36383793 | DOI:10.1590/1984-0462/2023/41/2021352

J Urol. 2022 Nov 16:101097JU0000000000003071. doi: 10.1097/JU.0000000000003071. Online ahead of print.

ABSTRACT

PURPOSE: To determine if the AUA recommended prophylaxis (vancomycin + gentamicin alone) for primary inflatable penile prosthesis (IPP) surgery is associated with a higher infection risk than non-standard regimens.

MATERIALS AND METHODS: We performed a multicenter, retrospective study of patients undergoing primary IPP surgery. Patients were divided into those receiving vancomycin + gentamicin alone and those receiving any other regimen. A Cox proportional-hazards model was constructed adjusted for major predictors. A subgroup analysis to identify the appropriate dosage of gentamicin was also performed.

RESULTS: 4,161 patients underwent primary IPP placement (2,411 received vancomycin + gentamicin alone and 1,750 received other regimens). The infection rate was similar between groups, 1 vs 1.2% for standard vs non-standard prophylaxis. In the multivariable analysis, vancomycin + gentamicin (HR: 2.7, 95%CI: 1.4-5.4, P = .004) and diabetes (HR: 1.9, 95%CI: 1.03-3.4, P = .04) were significantly associated with a higher risk of infection. Antifungals (HR: 0.08, 95%CI: 0.03-0.19, P<.001) were associated with lower risk of infection. There was no statistically significant difference in infection rate between weight-based gentamicin compared to 80 mg gentamicin (HR: 2.9, 95% CI: 0.83 to 10, P=.1).

CONCLUSIONS: Vancomycin + gentamicin alone for antibiotic prophylaxis for primary IPP surgery is associated with a higher infection risk than non-standard antibiotic regimens while antifungal use is associated with lower infection risk. A critical review of the recommended antimicrobial prophylactic regimens is needed. Prospective research is needed to further elucidate best practices in IPP antimicrobial prophylaxis.

PMID:36383789 | DOI:10.1097/JU.0000000000003071

J Urol. 2022 Nov 16:101097JU0000000000003069. doi: 10.1097/JU.0000000000003069. Online ahead of print.

ABSTRACT

BACKGROUND: The sentinel reference for antibiotic prophylaxis for radical cystectomy with ileal conduit (RCIC) in the AUA Guidelines reports data from 2003-2013 and has not been updated in the interim. Here, we assess adherence to antibiotic prophylaxis guidelines among patients undergoing radical cystectomy with ileal conduit for bladder cancer using a large national database. As a secondary objective, we assess the association between antimicrobial use and post-operative infection during the index admission following cystectomy.

METHODS: Premier Healthcare Database was queried for all patients undergoing cystectomy with ileal conduit with diagnosis of bladder cancer between 2015 and 2020. Antibiotics used and the duration of use was determined by charge codes and grouped as guidelines-based or not according to 2019 AUA Guidelines. Association with infectious complications was assessed by logistic mixed effects regression models.

RESULTS: Among 6,708 patients undergoing cystectomy with ileal conduit, only 28% (1843/6708) were given prophylaxis according to AUA guidelines. 1.8% (121/6708) of patients received an antifungal, and 37% (2482/6708) received extended duration prophylaxis beyond postoperative day 1. Patients who received guidelines-based prophylaxis were less likely to be diagnosed with a UTI (21% vs 24%, P = .04), pyelonephritis (5.1% vs 7.7%, P<.001), bacterial infection (24% vs 27%, P = .03), or pneumonia (12% vs 17%, P<.001). There was no statistically significant difference in clostridium difficile infection between guidelines-based and non-guidelines-based prophylaxis (3.2% vs 3.7%, P = .32). In a multivariable logistic regression adjusting for age, race, insurance, and hospital and provider characteristics, non-guideline antibiotic prophylaxis (OR 1.27 [1.12, 1.43], P<.001) was associated with an increased odds of infectious events, whereas a robotic approach (OR 0.82 [0.73, 0.92], P<.001) was associated with lower odds.

CONCLUSION: 73% of patients fail to receive guideline-based antibiotic prophylaxis when undergoing radical cystectomy with conduit, which was largely driven by extended duration antibiotic use. Despite the shorter duration of antibiotics, we found that guideline-based prophylaxis was associated with a 25% decrease in the odds of infectious complications. While residual confounding is possible, these data support current AUA guidelines and suggest a need for outreach to improve guideline adherence.

PMID:36383758 | DOI:10.1097/JU.0000000000003069

Clin Chem Lab Med. 2022 Nov 17. doi: 10.1515/cclm-2022-1006. Online ahead of print.

ABSTRACT

OBJECTIVES: Early recognition and timely intervention for urosepsis are key to reducing morbidity and mortality. Blood culture has low sensitivity, and a long turnaround time makes meeting the needs of clinical diagnosis difficult. This study aimed to use biomarkers to build a machine learning model for early prediction of urosepsis.

METHODS: Through retrospective analysis, we screened 157 patients with urosepsis and 417 patients with urinary tract infection. Laboratory data of the study participants were collected, including data on biomarkers, such as procalcitonin, D-dimer, and C-reactive protein. We split the data into training (80%) and validation datasets (20%) and determined the average model prediction accuracy through cross-validation.

RESULTS: In total, 26 variables were initially screened and 18 were statistically significant. The influence of the 18 variables was sorted using three ranking methods to further determine the best combination of variables. The Gini importance ranking method was found to be suitable for variable filtering. The accuracy rates of the six machine learning models in predicting urosepsis were all higher than 80%, and the performance of the artificial neural network (ANN) was the best among all. When the ANN included the eight biomarkers with the highest influence ranking, its model had the best prediction performance, with an accuracy rate of 92.9% and an area under the receiver operating characteristic curve of 0.946.

CONCLUSIONS: Urosepsis can be predicted using only the top eight biomarkers determined by the ranking method. This data-driven predictive model will enable clinicians to make quick and accurate diagnoses.

PMID:36383696 | DOI:10.1515/cclm-2022-1006

PLoS One. 2022 Nov 16;17(11):e0277785. doi: 10.1371/journal.pone.0277785. eCollection 2022.

ABSTRACT

BACKGROUND: In many of the risk estimation algorithms for patients with ST-elevation myocardial infarction (STEMI), heart rate and systolic blood pressure are key predictors. Yet, these parameters may also be altered by the applied medical treatment / circulatory support without concomitant improvement in microcirculation. Therefore, we aimed to investigate whether venous lactate level, a well-known marker of microcirculatory failure, may have an added prognostic value on top of the conventional variables of the “Global Registry of Acute Coronary Events” (GRACE) 2.0 model for predicting 30-day all-cause mortality of STEMI patients treated with primary percutaneous coronary intervention (PCI).

METHODS: In a prospective single-center registry study conducted from May 2020 through April 2021, we analyzed data of 323 cases. Venous blood gas analysis was performed in all patients at admission. Nested logistic regression models were built using the GRACE 2.0 score alone (base model) and with the addition of venous lactate level (expanded model) with 30-day all-cause mortality as primary outcome measure. Difference in model performance was analyzed by the likelihood ratio (LR) test and the integrated discrimination improvement (IDI). Independence of the predictors was evaluated by the variance inflation factor (VIF). Discrimination and calibration was characterized by the c-statistic and calibration intercept / slope, respectively.

RESULTS: Addition of lactate level to the GRACE 2.0 score improved the predictions of 30-day mortality significantly as assessed by both LR test (LR Chi-square = 8.7967, p = 0.0030) and IDI (IDI = 0.0685, p = 0.0402), suggesting that the expanded model may have better predictive ability than the GRACE 2.0 score. Furthermore, the VIF was 1.1203, indicating that the measured lactate values were independent of the calculated GRACE 2.0 scores.

CONCLUSIONS: Our results suggest that admission venous lactate level and the GRACE 2.0 score may be independent and additive predictors of 30-day all-cause mortality of STEMI patients treated with primary PCI.

PMID:36383629 | DOI:10.1371/journal.pone.0277785

PLoS Genet. 2022 Nov 16;18(11):e1010464. doi: 10.1371/journal.pgen.1010464. eCollection 2022 Nov.

ABSTRACT

The identification and understanding of gene-environment interactions can provide insights into the pathways and mechanisms underlying complex diseases. However, testing for gene-environment interaction remains a challenge since a.) statistical power is often limited and b.) modeling of environmental effects is nontrivial and such model misspecifications can lead to false positive interaction findings. To address the lack of statistical power, recent methods aim to identify interactions on an aggregated level using, for example, polygenic risk scores. While this strategy can increase the power to detect interactions, identifying contributing genes and pathways is difficult based on these relatively global results. Here, we propose RITSS (Robust Interaction Testing using Sample Splitting), a gene-environment interaction testing framework for quantitative traits that is based on sample splitting and robust test statistics. RITSS can incorporate sets of genetic variants and/or multiple environmental factors. Based on the user’s choice of statistical/machine learning approaches, a screening step selects and combines potential interactions into scores with improved interpretability. In the testing step, the application of robust statistics minimizes the susceptibility to main effect misspecifications. Using extensive simulation studies, we demonstrate that RITSS controls the type 1 error rate in a wide range of scenarios, and we show how the screening strategy influences statistical power. In an application to lung function phenotypes and human height in the UK Biobank, RITSS identified highly significant interactions based on subcomponents of genetic risk scores. While the contributing single variant interaction signals are weak, our results indicate interaction patterns that result in strong aggregated effects, providing potential insights into underlying gene-environment interaction mechanisms.

PMID:36383614 | DOI:10.1371/journal.pgen.1010464

JAMA Netw Open. 2022 Nov 1;5(11):e2242240. doi: 10.1001/jamanetworkopen.2022.42240.

ABSTRACT

IMPORTANCE: Herpes zoster infection after COVID-19 vaccination has been reported in numerous case studies. It is not known whether these cases represent increased reporting or a true increase in risk.

OBJECTIVE: To assess whether COVID-19 vaccination is associated with an increased risk of herpes zoster infection.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a self-controlled risk interval (SCRI) design to compare the risk of herpes zoster in a risk interval of 30 days after COVID-19 vaccination or up to the date of the second vaccine dose with a control interval remote from COVID-19 vaccination (defined as 60-90 days after the last recorded vaccination date for each individual, allowing for a 30-day washout period between control and risk intervals). A supplemental cohort analysis was used to compare the risk of herpes zoster after COVID-19 vaccination with the risk of herpes zoster after influenza vaccination among 2 historical cohorts who received an influenza vaccine in the prepandemic period (January 1, 2018, to December 31, 2019) or the early pandemic period (March 1, 2020, to November 30, 2020). Data were obtained from Optum Labs Data Warehouse, a US national deidentified claims-based database. A total of 2 039 854 individuals who received any dose of a COVID-19 vaccine with emergency use authorization (BNT162b2 [Pfizer-BioNTech], mRNA-1273 [Moderna], or Ad26.COV2.S [Johnson & Johnson]) from December 11, 2020, through June 30, 2021, were eligible for inclusion. Individuals included in the SCRI analysis were a subset of the COVID-19-vaccinated cohort who had herpes zoster during either a risk or control interval.

EXPOSURES: Any dose of a COVID-19 vaccine.

MAIN OUTCOMES AND MEASURES: Incident herpes zoster, defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes and a prescription of a new antiviral medication or a dose increase in antiviral medication within 5 days of diagnosis.

RESULTS: Among 2 039 854 individuals who received any dose of a COVID-19 vaccine during the study period, the mean (SD) age was 43.2 (16.3) years; 1 031 149 individuals (50.6%) were female, and 1 344 318 (65.9%) were White. Of those, 1451 patients (mean [SD] age, 51.6 [12.6] years; 845 [58.2%] female) with a herpes zoster diagnosis were included in the primary SCRI analysis. In the SCRI analysis, COVID-19 vaccination was not associated with an increased risk of herpes zoster after adjustment (incidence rate ratio, 0.91; 95% CI, 0.82-1.01; P = .08). In the supplementary cohort analysis, COVID-19 vaccination was not associated with a higher risk of herpes zoster compared with influenza vaccination in the prepandemic period (first dose of COVID-19 vaccine: hazard ratio [HR], 0.78 [95% CI, 0.70-0.86; P < .001]; second dose of COVID-19 vaccine: HR, 0.79 [95% CI, 0.71-0.88; P < .001]) or the early pandemic period (first dose of COVID-19 vaccine: HR, 0.89 [95% CI, 0.80-1.00; P = .05]; second dose: HR, 0.91 [95% CI, 0.81-1.02; P = .09]).

CONCLUSIONS AND RELEVANCE: In this study, there was no association found between COVID-19 vaccination and an increased risk of herpes zoster infection, which may help to address concerns about the safety profile of the COVID-19 vaccines among patients and clinicians.

PMID:36383382 | DOI:10.1001/jamanetworkopen.2022.42240