Tag: pubmed

BMC Pregnancy Childbirth. 2022 Aug 4;22(1):613. doi: 10.1186/s12884-022-04947-x.

ABSTRACT

BACKGROUND: Out-of-pocket payment (OOPP) is reported to be a major barrier to seeking maternal health care especially among the poor and can expose households to a risk of catastrophic expenditure and impoverishment.This study examined the OOPPs women made during childbirth in the Upper West region of Ghana.

METHODS: We carried out a cross-sectional study and interviewed women who gave birth between January 2013 and December 2017. Data on socio-demographic characteristics, place of childbirth, as well as direct cost (medical and non-medical) were collected from respondents. The costs of childbirth were estimated from the patient perspective. Logistics regression was used to assess the factors associated with catastrophic payments cost. All analyses were done using STATA 16.0.

RESULTS: Out of the 574 women interviewed, about 71% (406/574) reported OOPPs on their childbirth. The overall average direct medical and non-medical expenditure women made on childbirth was USD 7.5. Cost of drugs (USD 8.0) and informal payments (UDD 5.7) were the main cost drivers for medical and non-medical costs respectively. Women who were enrolled into the National Health Insurance Scheme (NHIS) spent a little less (USD 7.5) than the uninsured women (USD 7.9). Also, household childbirth expenditure increased from primary health facilities level (community-based health planning and services compound = USD7.2; health centre = USD 6.0) to secondary health facilities level (hospital = USD11.0); while home childbirth was USD 4.8. Overall, at a 10% threshold, 21% of the respondents incurred catastrophic health expenditure. Regression analysis showed that place of childbirth and household wealth were statistically significant factors associated with catastrophic payment.

CONCLUSIONS: The costs of childbirth were considerably high with a fifth of households spending more than one-tenth of their monthly income on childbirth and therefore faced the risk of catastrophic payments and impoverishment. Given the positive effect of NHIS on cost of childbirth, there is a need to intensify efforts to improve enrolment to reduce direct medical costs as well as sensitization and monitoring to reduce informal payment. Also, the identified factors that influence cost of childbirth should be considered in strategies to reduce cost of childbirth.

PMID:35927635 | DOI:10.1186/s12884-022-04947-x

BMC Pregnancy Childbirth. 2022 Aug 4;22(1):615. doi: 10.1186/s12884-022-04943-1.

ABSTRACT

BACKGROUND: Small-for-gestational-age neonates (SGA) are at increased risk of neonatal morbidity. Nulliparity represents a risk factor for SGA; birthweight charts may perform differently for the detection of SGA among nulliparas. This study aimed at describing the prevalence of SGA in nulliparas according to different birthweight charts and evaluating the diagnostic performance of these charts to maternal and perinatal outcomes.

METHODS: This is a secondary analysis of a Brazilian cohort of nulliparas named Preterm SAMBA study. Birthweight centiles were calculated using the Intergrowth-21st, WHO-Fetal Growth Charts, Birth in Brazil population chart and GROW-customised chart. The risks of outcomes among SGA neonates and their mothers in comparison to neonates with birthweights between the 40^th-60^th centiles were calculated, according to each chart. ROC curves were used to detect neonatal morbidity in neonates with birth weights below different cutoff centiles for each chart.

RESULTS: A sample of 997 nulliparas was assessed. The rate of SGA infants varied between 7.0-11.6%. All charts showed a significantly lower risk of caesarean sections in women delivering SGA neonates compared to those delivering adequate-for-gestational-age neonates (OR 0.55-0.64, p < .05). The charts had poor performance (AUC 0.492 – 0.522) for the detection of neonatal morbidity related to SGA born at term.

CONCLUSION: The populational and customised birthweight charts detected different prevalence of small-for-gestational-age neonates and showed similar and poor performance to identify related neonatal adverse outcomes in this population.

PMID:35927626 | DOI:10.1186/s12884-022-04943-1

J Headache Pain. 2022 Aug 4;23(1):95. doi: 10.1186/s10194-022-01465-1.

ABSTRACT

BACKGROUND: The diagnosis of migraine is mainly clinical and self-reported, which makes additional examinations unnecessary in most cases. Migraine can be subtyped into chronic (CM) and episodic (EM). Despite the very high prevalence of migraine, there are no evidence-based guidelines for differentiating between these subtypes other than the number of days of migraine headache per month. Thus, we consider it timely to perform a systematic review to search for physiological evidence from functional activity (as opposed to anatomical structure) for the differentiation between CM and EM, as well as potential functional biomarkers. For this purpose, Web of Science (WoS), Scopus, and PubMed databases were screened.

FINDINGS: Among the 24 studies included in this review, most of them (22) reported statistically significant differences between the groups of CM and EM. This finding is consistent regardless of brain activity acquisition modality, ictal stage, and recording condition for a wide variety of analyses. That speaks for a supramodal and domain-general differences between CM and EM that goes beyond a differentiation based on the days of migraine per month. Together, the reviewed studies demonstrates that electro- and magneto-physiological brain activity (M/EEG), as well as neurovascular and metabolic recordings from functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), show characteristic patterns that allow to differentiate between CM and EM groups.

CONCLUSIONS: Although a clear brain activity-based biomarker has not yet been identified to distinguish these subtypes of migraine, research is approaching headache specialists to a migraine diagnosis based not only on symptoms and signs reported by patients. Future studies based on M/EEG should pay special attention to the brain activity in medium and fast frequency bands, mainly the beta band. On the other hand, fMRI and PET studies should focus on neural circuits and regions related to pain and emotional processing.

PMID:35927625 | DOI:10.1186/s10194-022-01465-1

BMC Med Res Methodol. 2022 Aug 4;22(1):210. doi: 10.1186/s12874-022-01697-4.

NO ABSTRACT

PMID:35927619 | DOI:10.1186/s12874-022-01697-4

BMC Neurol. 2022 Aug 4;22(1):290. doi: 10.1186/s12883-022-02814-y.

ABSTRACT

BACKGROUND: Even with high standards of acute care and neurological early rehabilitation (NER) a substantial number of patients with neurological conditions still need mechanical ventilation and/or airway protection by tracheal cannulas when discharged and hence home-based specialised intensive care nursing (HSICN). It may be possible to improve the home care situation with structured specialized long-term neurorehabilitation support and following up patients with neurorehabilitation teams. Consequently, more people might recover over an extended period to a degree that they were no longer dependent on HSICN.

METHODS: This healthcare project and clinical trial implements a new specialised neurorehabilitation outreach service for people being discharged from NER with the need for HSICN. The multicentre, open, parallel-group RCT compares the effects of one year post-discharge specialized outpatient follow-up to usual care in people receiving HSICN. Participants will randomly be assigned to receive the new form of healthcare (intervention) or the standard healthcare (control) on a 2:1 basis. Primary outcome is the rate of weaning from mechanical ventilation and/or decannulation (primary outcome) after one year, secondary outcomes include both clinical and economic measures. 173 participants are required to corroborate a difference of 30 vs. 10% weaning success rate statistically with 80% power at a 5% significance level allowing for 15% attrition.

DISCUSSION: The OptiNIV-Study will implement a new specialised neurorehabilitation outreach service and will determine its weaning success rates, other clinical outcomes, and cost-effectiveness compared to usual care for people in need for mechanical ventilation and/or tracheal cannula and hence HSICN after discharge from NER.

TRIAL REGISTRATION: The trial OptiNIV has been registered in the German Clinical Trials Register (DRKS) since 18.01.2022 with the ID DRKS00027326 .

PMID:35927616 | DOI:10.1186/s12883-022-02814-y

BMC Bioinformatics. 2022 Aug 4;23(1):315. doi: 10.1186/s12859-022-04853-1.

ABSTRACT

BACKGROUND: Genetic and epigenetic biological studies often combine different types of experiments and multiple conditions. While the corresponding raw and processed data are made available through specialized public databases, the processed files are usually limited to a specific research question. Hence, they are unsuitable for an unbiased, systematic overview of a complex dataset. However, possible combinations of different sample types and conditions grow exponentially with the amount of sample types and conditions. Therefore the risk to miss a correlation or to overrate an identified correlation should be mitigated in a complex dataset. Since reanalysis of a full study is rarely a viable option, new methods are needed to address these issues systematically, reliably, reproducibly and efficiently.

RESULTS: Cogito “COmpare annotated Genomic Intervals TOol” provides a workflow for an unbiased, structured overview and systematic analysis of complex genomic datasets consisting of different data types (e.g. RNA-seq, ChIP-seq) and conditions. Cogito is able to visualize valuable key information of genomic or epigenomic interval-based data, thereby providing a straightforward analysis approach for comparing different conditions. It supports getting an unbiased impression of a dataset and developing an appropriate analysis strategy for it. In addition to a text-based report, Cogito offers a fully customizable report as a starting point for further in-depth investigation.

CONCLUSIONS: Cogito implements a novel approach to facilitate high-level overview analyses of complex datasets, and offers additional insights into the data without the need for a full, time-consuming reanalysis. The R/Bioconductor package is freely available at https://bioconductor.org/packages/release/bioc/html/Cogito.html , a comprehensive documentation with detailed descriptions and reproducible examples is included.

PMID:35927614 | DOI:10.1186/s12859-022-04853-1

Obstet Gynecol. 2022 Aug 3. doi: 10.1097/AOG.0000000000004888. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify factors associated with intrauterine tamponade failure after vaginal or cesarean delivery.

METHODS: This was a nationwide population-based cohort study that used data from the French Programme de Médicalisation des Systèmes d’Information. This study compared the failure and effectiveness of intrauterine tamponade among all women who received the procedure in France from January 1, 2019, to December 31, 2019. Failure was defined as the use of a second-line method (uterine artery embolization, conservative or radical surgery, or death) within 7 days of intrauterine tamponade. Factors associated with intrauterine tamponade failure were identified by univariate analyses and tested using multivariate generalized logistic regression models (with a random intercept on institution) to obtain adjusted odds ratio (aOR) and 95% CI statistics.

RESULTS: A total of 39,193 patients presented with postpartum hemorrhage in 474 French maternity wards. Of these patients, 1,761 (4.5%) received intrauterine tamponade for persistent bleeding. The effectiveness rate of intrauterine tamponade was 88.9%. For 195 women (11.1%), a second-line method was indicated. Patients for whom intrauterine tamponade failed had a higher maternal age, a lower mean gestational age, and more frequent instances of placental abnormalities, preeclampsia, cesarean birth, and uterine rupture. The multivariate analysis revealed that cesarean birth (aOR 4.2; 95% CI 2.9-6.0), preeclampsia (aOR 2.3; 95% CI 1.3-4.0), and uterine rupture (aOR 14.1; 95% CI 2.4-83.0) were independently associated with intrauterine tamponade failure.

CONCLUSION: Cesarean delivery, preeclampsia, and uterine rupture are associated with intrauterine tamponade failure in the management of postpartum hemorrhage.

PMID:35926196 | DOI:10.1097/AOG.0000000000004888

Wound Manag Prev. 2022 Aug;68(8):25-32.

ABSTRACT

BACKGROUND: Many health-related videos are available online. One type of health-related video is related to stoma pouch change. However, a system to evaluate the quality and content of these videos is lacking.

PURPOSE: To evaluate the content and quality of YouTube videos on colostomy pouch change.

METHODS: A descriptive study was carried out by searching for videos on March 15, 2021, using the key words “colostomy care,” “colostomy bag/pouch change,” and “ostomy bag/pouch change.” A 5-point Global Quality Scale was used to evaluate the quality of the videos, and a 10-point scale was used to evaluate the content. The videos were classified as “useful” or “useless” according to their content and quality scores.

RESULTS: A total of 128 videos were found; 94 videos met the criteria and were included in the study. The content of the 94 videos was examined by 2 independent researchers. The overall content score of the videos was 8.24 ± 1.56, and the overall quality score was 3.14 ± 0.97. A total of 66 (70.21%) videos were useful, and 28 (29.79%) videos were useless. The mean scores of useful videos for content (9.09 ± 0.83) and the average Global Quality Scale scores (3.53 ± 0.76) were significantly higher than those of useless videos (6.17 ± 0.90 and 2.25 ± 0.75, respectively; (P < .05). The results showed that 57.6% of the useful videos were uploaded by universities, professional organizations, and health care professionals, and 67.9% of the useless videos were uploaded by patients; the difference was statistically significant (P < .05).

CONCLUSIONS: Results indicated that the majority of online videos evaluated were accurate. Most of these videos were uploaded by universities, professional organizations, health care professionals, or medical advertisers. Although there were many limitations to this study, the authors suggest that health care professionals can direct their patients to these sources after hospital discharge. However, future studies are needed..

PMID:35926146

Nurse Educ. 2022 Aug 1. doi: 10.1097/NNE.0000000000001264. Online ahead of print.

ABSTRACT

BACKGROUND: The Doctor of Nursing Practice (DNP) project is the culmination of DNP education, serving as evidence of knowledge preparation and skill achievement in translating evidence into practice.

PROBLEM: Review of sample DNP projects from 2015 to 2019 revealed that multiple projects had fatal flaws in the Methods and Evaluation sections, rendering the resulting DNP project with diminished value.

APPROACH: We established a collaborative relationship with an educational statistics program and associated consulting center to develop and integrate statistical resources directly into the planning and evaluating stages of the DNP project process. The pilot program included workshops and individual consulting sessions provided to the student aimed at reducing fatal flaws and improving research design and evaluation analyses.

OUTCOMES: Initial and follow-up surveys were adapted from the Course Experience Questionnaire to assess student satisfaction and perceived knowledge gains. Project rigor and value were assessed using the DNP-Project Critical Appraisal Tool (PCAT).

CONCLUSIONS: The pilot program showed a decrease in the number of fatal flaws and an increase in PCAT scores on the targeted Design and Evaluation sections.

PMID:35926107 | DOI:10.1097/NNE.0000000000001264

Ann Am Thorac Soc. 2022 Aug 4. doi: 10.1513/AnnalsATS.202204-328OC. Online ahead of print.

ABSTRACT

RATIONALE: Historically sarcoidosis was described as a restrictive lung disease, but several alternative phenotypes of pulmonary function have been observed. Pulmonary function phenotypes in sarcoidosis may represent different clinical and/or molecular phenotypes.

OBJECTIVE: To characterize the prevalence of different pulmonary function phenotypes in a large and diverse sarcoidosis cohort from a tertiary care referral center.

METHODS: We identified individuals seen between 2005-2015 with a confirmed diagnosis of sarcoidosis. Data were collected from the first pulmonary function test (PFT) performed at our institution which included spirometry and diffusing capacity (DLCO). Demographics and clinical data were collected. Chi-squared analyses and multiple linear regressions were done to assess statistical differences and associations. Global Lung Function Initiative equations were used to calculate percent predicted measurements for spirometry and DLCO.

RESULTS: Of 602 individuals with sarcoidosis, 93% (562) had pulmonary involvement, 64% (385) were female, and 57% (341) were Black. Of those with pulmonary involvement, 56% had abnormal pulmonary function. Lung function impairment phenotypes included: 47% restriction, 22% obstruction, 15% isolated reduction in DLCO, and 16% combined obstructive restrictive phenotype. Restriction was the most common PFT phenotype among Black individuals (41%), while no lung impairment was most common among White individuals (66%) (p<0.001). Males more frequently had obstruction (19%) compared to females (9%) p=0.001, and females had more restriction (30%) compared to males (21%) p=0.031.

CONCLUSIONS: Among individuals with sarcoidosis and pulmonary function impairment, less than half demonstrated a restrictive phenotype. There were significant differences in pulmonary function phenotypes by race and sex.

PMID:35926103 | DOI:10.1513/AnnalsATS.202204-328OC