Tag: pubmed

JPEN J Parenter Enteral Nutr. 2022 Oct 9. doi: 10.1002/jpen.2455. Online ahead of print.

ABSTRACT

BACKGROUND: There is controversy regarding the optimal timing of initiating PN in critically ill patients. We aimed to evaluate the association between early PN and clinical outcomes and explore the mediation effects of different macronutrients in a cohort of mechanically ventilated patients.

METHODS: This is a post-hoc analysis of the NEED trial aiming to investigate the effect of implementing an evidence-based feeding guideline in newly-admitted critically ill patients. All eligible patients were divided into those who received early PN within the first three days of enrollment (Early PN) or those who did not (Non-early PN). Propensity score matching (PSM) with a one-to-one nearest neighbor-matching algorithm was applied to control potential confounders. Mediation analysis was used to test the indirect effect of different macronutrients from PN on the relationship between early PN and 28-day mortality.

RESULTS: The PSM created 370 matched pairs out of 1154 patients that met the eligibility criteria. Compared with non-early PN, patients receiving early PN had significantly higher 28-day mortality (19.7% versus 12.4%; hazard ratio = 1.904, 95% confidence interval [CI]: 1.063-3.410, P = 0.03). Mediation analysis showed that amino acids from early PN mediated 65% (mediation effect = 0.07, 95% CI: 0.02-0.13, P = 0.01) of the detrimental effect of early PN on the 28-day mortality.

CONCLUSIONS: Early PN is associated with increased 28-day mortality in critically ill patients requiring invasive mechanical ventilation. The detrimental effect may be mediated by intravenous amino acids from early PN. This article is protected by copyright. All rights reserved.

PMID:36209461 | DOI:10.1002/jpen.2455

Ultrastruct Pathol. 2022 Jul 4;46(4):388-400. doi: 10.1080/01913123.2022.2107750.

ABSTRACT

Congenital granular cell epulis (CGCE) is a rare tumor of gingiva that is exclusive to newborns, has marked female predominance, and is rarely associated with other abnormalities. Although benign in behavior, CGCE can be lethal by obstruction of respiration and/or deglutition and can require a multidisciplinary team of specialist at birth for survival of an otherwise normal infant. Histologically, CGCE resembles granular cell tumor (GCT), but unlike GCT, which is Schwannian-derived, derivation of CGCE remains an enigma, largely because of its low prevalence. This study presents 24 new cases of CGCE, the largest series since the original description 150 years ago and permits detailed study of homogeneity of cases diagnosed as CGCE as well as detailed comparisons of CGCE with GCT by clinical, morphological, immunohistochemical, and ultrastructural studies. The data show homogeneity within the CGCE cases, more differences than similarities between CGCE and GCT, and no immunohistochemical staining for common placental proteins/hormones in CGCE. The findings support a primitive mesenchymal cell origin, and a progressive degenerative process in CGCE, rather than neoplasia. Prenatal detection of this lesion is important to facilitate adequate preparations for support of these infants during labor and delivery.

PMID:36209431 | DOI:10.1080/01913123.2022.2107750

J Math Biol. 2022 Oct 9;85(5):48. doi: 10.1007/s00285-022-01807-2.

ABSTRACT

The complexity of biological systems, and the increasingly large amount of associated experimental data, necessitates that we develop mathematical models to further our understanding of these systems. Because biological systems are generally not well understood, most mathematical models of these systems are based on experimental data, resulting in a seemingly heterogeneous collection of models that ostensibly represent the same system. To understand the system we therefore need to understand how the different models are related to each other, with a view to obtaining a unified mathematical description. This goal is complicated by the fact that a number of distinct mathematical formalisms may be employed to represent the same system, making direct comparison of the models very difficult. A methodology for comparing mathematical models based on their underlying conceptual structure is therefore required. In previous work we developed an appropriate framework for model comparison where we represent models, specifically the conceptual structure of the models, as labelled simplicial complexes and compare them with the two general methodologies of comparison by distance and comparison by equivalence. In this article we continue the development of our model comparison methodology in two directions. First, we present a rigorous and automatable methodology for the core process of comparison by equivalence, namely determining the vertices in a simplicial representation, corresponding to model components, that are conceptually related and the identification of these vertices via simplicial operations. Our methodology is based on considerations of vertex symmetry in the simplicial representation, for which we develop the required mathematical theory of group actions on simplicial complexes. This methodology greatly simplifies and expedites the process of determining model equivalence. Second, we provide an alternative mathematical framework for our model-comparison methodology by representing models as groups, which allows for the direct application of group-theoretic techniques within our model-comparison methodology.

PMID:36209430 | DOI:10.1007/s00285-022-01807-2

Orv Hetil. 2022 Oct 9;163(41):1639-1648. doi: 10.1556/650.2022.32580. Print 2022 Oct 9.

ABSTRACT

INTRODUCTION: Ensuring the supply of healthcare professionals is an important health policy issue nowadays.

OBJECTIVE: The aim of our research is to provide a comprehensive picture of the health workforce situation in the European OECD countries.

DATA AND METHODS: Indicators analyzed regarding the numbers of practising midwives, nurses, physiotherapists and total hospital beds were derived from the “OECD Health Statistics 2021” database for the period 2000-2018. 24 European OECD countries were grouped according to the type of healthcare system and geographical location. Data were subsequently compared by parametric and nonparametric tests, focusing especially on years 2000, 2010, 2018.

RESULTS: Between 2000 and 2018, there was a 14% increase in the average number of midwives, a 30% increase in the average number of nurses, and a 41% increase in the average number of physiotherapists per 100,000 population in the OECD countries examined. Per 100 hospital beds, the average number of midwives increased by 72%, the number of nurses by 86%, and the number of physiotherapists by 97%. Significant results for all three years analyzed were obtained in the number of physiotherapists per 100 hospital beds (p = 0.014; p<0.001; p = 0.002) when comparing the Western and Eastern European countries examined. As for the healthcare systems, significant results were obtained only in the number of nurses per 100 hospital beds for the year 2010 (p = 0.048).

CONCLUSION: Among healthcare professional groups, the number of physiotherapists increased the most in Europe. The numbers of healthcare professionals per 100 beds are significantly higher in Western European countries analyzed compared to Eastern European countries. Orv Hetil. 2022; 163(41): 1639-1648.

PMID:36209424 | DOI:10.1556/650.2022.32580

Brief Bioinform. 2022 Oct 8:bbac417. doi: 10.1093/bib/bbac417. Online ahead of print.

ABSTRACT

Existing methods for differential network analysis could only infer whether two networks of interest have differences between two groups of samples, but could not quantify and localize network differences. In this work, a novel method, permutation-based Network True Discovery Proportions (NetTDP), is proposed to quantify the number of edges (correlations) or nodes (genes) for which the co-expression networks are different. In the NetTDP method, we propose an edge-level statistic and a node-level statistic, and detect true discoveries of edges and nodes in the sense of differential co-expression network, respectively, by the permutation-based sumSome method. Furthermore, the NetTDP method could further localize the differences by inferring the TDPs for edge or gene subsets of interest, which can be selected post hoc. Our NetTDP method allows inference on data-driven modules or biology-driven gene sets, and remains valid even when these sub-networks are optimized using the same data. Experimental results on both simulation data sets and five real data sets show the effectiveness of the proposed method in inferring the quantification and localization of differential co-expression networks. The R code is available at https://github.com/LiminLi-xjtu/NetTDP.

PMID:36209415 | DOI:10.1093/bib/bbac417

Psychooncology. 2022 Oct 9. doi: 10.1002/pon.6045. Online ahead of print.

ABSTRACT

BACKGROUND: It is imperative to provide care for patients with terminal illnesses such as cancer, though it demands time, financial resources and other unmet needs. Subsequently, caregivers might be exposed to psychological stress and other mental health problems. Previous meta-analysis finding shows caregivers of cancer patient suffer from depression. During the past four years, there has been a considerable increase in the number of newly studies, and we therefore intended to update this finding and provide current global prevalence of depression among caregivers of Cancer patients.

METHODS: We searched PubMed, SCOPUS, CINAHIL, Embase, and PsychINFO to identify peer-reviewed studies which reported the prevalence of depression among caregivers of cancer patients using pre-defined eligibility criteria. Studies were pooled to estimate the global prevalence of depression using a random-effect meta-analysis model. Heterogeneity was assessed using Cochran’s Q and I² – statistics. Funnel plot asymmetry and Egger’s regression tests were used to check for publication bias.

RESULT: Our search identified 4375 studies, of which 35 studies with 11,396 participants were included in the meta-analysis. In the current review, the pooled prevalence of depression among caregivers of Cancer patients was 42.08% (95% CI: 34.71-49.45). The pooled prevalence of depression was higher in the studies that used cross-sectional data (42%, 95% CI: 31-52) than longitudinal data (34%, 95%CI: 18-50). We also observed a higher rate of depression among female caregivers when compared to their male counterparts (57.6%) (95% CI: 29.5-81.5).

CONCLUSION: Globally, around two in five cancer patient caregivers screened positive for depression, which needs due attention. Routine screening of depressive symptoms and providing psychosocial support for caregivers is crucial. This article is protected by copyright. All rights reserved.

PMID:36209385 | DOI:10.1002/pon.6045

Dermatol Ther. 2022 Oct 9:e15913. doi: 10.1111/dth.15913. Online ahead of print.

ABSTRACT

BACKGROUND: Alopecia areata (AA) is a disease that affects the psychological well-being of the affected individuals. Laser-assisted drug delivery and micro needling are promising methods for the treatment of different dermatological diseases.

AIM: The aim of the study was to compare the efficacy of topical application of triamcinolone acetonide after fractional carbon dioxide laser versus micro-needling in the treatment of resistant alopecia areata from a clinical and dermoscopic perspective.

PATIENTS AND METHODS: Thirty patients were randomly divided into two groups of 15 patients each: the Laser group received fractional CO2 laser treatment followed by topical application of triamcinolone acetonide, and the Micro-needling group received dermapen treatment followed by topical application of triamcinolone acetonide.

RESULTS: In our study, we found no statistically significant difference between the studied groups before and after treatment, except for black dot, which is higher in the microneedling group than in the laser group (46.7% versus 13.3%). There is a statistically significant difference between the studied groups in terms of treatment response at the first follow-up, with 13.3% of the laser group seeing terminal hair regrowth compared to 0 in the microneedling group after 12 weeks. Regarding the degree of improvement, there was no statistically significant difference between the laser group and the microneedling group.

CONCLUSION: The use of fractional CO2 laser and microneedling for transepidermal drug delivery (TED) allowed for more uniform drug distribution. There was no significant difference between the two treatment methods in terms of their high effectiveness in the treatment of resistant alopecia areata. This article is protected by copyright. All rights reserved.

PMID:36209381 | DOI:10.1111/dth.15913

Worldviews Evid Based Nurs. 2022 Oct 8. doi: 10.1111/wvn.12606. Online ahead of print.

ABSTRACT

BACKGROUND: Adverse psychological outcomes are prevalent among family members of intensive care unit (ICU) patients. The facilitated sensemaking model (FSM) provides a framework for understanding how intensive care nurses can help these family members overcome situations in which a loved one is critically ill, and reduce adverse psychological outcomes through the facilitated sensemaking process.

AIMS: This study aimed to implement FSM-based research performed by ICU nurses and patients’ family members to investigate the impact of the facilitated sensemaking intervention on the psychological status of ICU families.

METHODS: The intervention was performed by nurses on 80 family members of mechanically ventilated patients, 40 in the control group and 40 in the experimental group. The control group only received routine medical services, while the experimental group received the nursing intervention based on FSM in addition to routine medical services. Anxiety, depression, and post-traumatic stress disorder (PTSD) were measured with the Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Post-Traumatic Stress Disorder Check-List-Civilian Version (PCL-C), respectively. SPSS version 25.0 was applied to analyze the data; what is more, some statistical methods, including descriptive statistical analysis, chi-square test and t-test were further adopted.

RESULTS: Before the intervention, there were no significant differences in anxiety, depression, and PTSD of family members of ICU mechanical ventilation patients between the two groups (p > .05). After the intervention, the score of anxiety, depression, and PTSD of family members in the control group and the experimental group were 41.50 ± 5.738 versus 36.50 ± 4.385, p < .001; 45.28 ± 8.089 versus 42.13 ± 5.725, p < .05; and 30.55 ± 7.595 versus 27.55 ± 4.696, p < .05, respectively. The nursing intervention based on FSM significantly alleviated anxiety, depression, and PTSD of mechanical ventilation patients’ family members.

LINKING EVIDENCE TO ACTION: The nursing intervention based on FSM significantly alleviated anxiety, depression, and PTSD of mechanical ventilation patients’ family members. However, there was only a statistically significant difference in the avoidance and numbness symptom cluster of PTSD via the PCL-C. Therefore, the observation time after the implementation of the FSM intervention needs to be extended in the future to clarify the effect of the intervention. Further efforts by advanced practice nurses and the cooperation of patients’ families are required to incorporate this intervention into ICU practice.

PMID:36209358 | DOI:10.1111/wvn.12606

Obes Surg. 2022 Oct 8. doi: 10.1007/s11695-022-06297-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Several modalities have been proposed to tackle insufficient weight loss and weight regain after bariatric surgery; we aimed to evaluate efficacy and safety of duodenal switch conversion as a salvage procedure.

MATERIAL AND METHODS: Data from patients who underwent duodenal switch conversions (n = 50) were retrospectively studied. Excess weight loss % and total body weight loss % were compared between primary procedure and duodenal switch conversion. Overall complication, emergency department visits, readmissions, reoperation, and mortality rates were described, analyzed, and compared to the current literature.

RESULTS: Every excess weight loss % and total body weight loss % comparison at 6, 12, and 24 months, demonstrated a statistically significant superiority in weight loss after duodenal switch conversion (p < 0.05). The mean operative time of adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass (1 and 2 stages) conversions to duodenal switch were 208, 146, 187, and 152 min, respectively, while the mean length of stay was 3.38 days. No statistically significant differences were perceived regarding the primary procedure. The overall complication rate was 18% (9 patients); 3 patients (6%) had 1 emergency department visit; readmissions accounted for 12% of cases (6 patients); the reoperation rate was 10% (5 patients); no fatal outcomes were recorded.

CONCLUSION: Duodenal switch conversions are an effective salvage procedure for insufficient weight loss and/or weight regain after adjustable gastric band, sleeve gastrectomy, and Roux-en-Y gastric bypass; it is also safe, associated to low readmission, reoperation, and mortality rates.

PMID:36209345 | DOI:10.1007/s11695-022-06297-1

Sci Rep. 2022 Oct 8;12(1):16913. doi: 10.1038/s41598-022-20724-4.

ABSTRACT

COVID-19 mortality risk stratification tools could improve care, inform accurate and rapid triage decisions, and guide family discussions regarding goals of care. A minority of COVID-19 prognostic tools have been tested in external cohorts. Our objective was to compare machine learning algorithms and develop a tool for predicting subsequent clinical outcomes in COVID-19. We conducted a retrospective cohort study that included hospitalized patients with COVID-19 from March 2020 to March 2021. Seven Hundred Twelve consecutive patients from University of Washington and 345 patients from Tongji Hospital in China were included. We applied three different machine learning algorithms to clinical and laboratory data collected within the initial 24 h of hospital admission to determine the risk of in-hospital mortality, transfer to the intensive care unit, shock requiring vasopressors, and receipt of renal replacement therapy. Mortality risk models were derived, internally validated in UW and externally validated in Tongji Hospital. The risk models for ICU transfer, shock and RRT were derived and internally validated in the UW dataset but were unable to be externally validated due to a lack of data on these outcomes. Among the UW dataset, 122 patients died (17%) during hospitalization and the mean days to hospital mortality was 15.7 +/- 21.5 (mean +/- SD). Elastic net logistic regression resulted in a C-statistic for in-hospital mortality of 0.72 (95% CI, 0.64 to 0.81) in the internal validation and 0.85 (95% CI, 0.81 to 0.89) in the external validation set. Age, platelet count, and white blood cell count were the most important predictors of mortality. In the sub-group of patients > 50 years of age, the mortality prediction model continued to perform with a C-statistic of 0.82 (95% CI:0.76,0.87). Prediction models also performed well for shock and RRT in the UW dataset but functioned with lower accuracy for ICU transfer. We trained, internally and externally validated a prediction model using data collected within 24 h of hospital admission to predict in-hospital mortality on average two weeks prior to death. We also developed models to predict RRT and shock with high accuracy. These models could be used to improve triage decisions, resource allocation, and support clinical trial enrichment.

PMID:36209335 | DOI:10.1038/s41598-022-20724-4