Tag: pubmed

Graefes Arch Clin Exp Ophthalmol. 2022 May 26. doi: 10.1007/s00417-022-05709-3. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate the effect of day-long face mask wearing on non-invasive tear break-up time (NI-BUT) in health care staff due to working schedules.

METHODS: Seventy-four right eyes of 74 participants were included in the study. Participants completed the Ocular Surface Disease Index (OSDI) questionnaire, and NI-BUT measurements were performed between 08.30-09.00 and 16.30-17.00 h. Participants with an initial NI-BUT measurement below 17 s were classified as group-1, and those over 17 s were classified as group-2. NI-BUT changes during the day and correlation to age, gender, and OSDI results were evaluated.

RESULTS: Thirty-eight women and 36 men, with a mean age of 30.9 ± 8.5 years, were included in the study. The mean OSDI score of the participants was 28.6 ± 17.1. NI-BUT means of group-1 at baseline and 8th hour were 11.4 ± 3.3 and 7.9 ± 3.6 s, respectively, and the mean NI-BUT at the 8th hour was statistically significantly lower than the baseline (p < 0.0001). Also, 24.2% (8 people) of those in group-2 had the 8th-hour NI-BUT value fallen into the measurable range (below 17 s). No significant correlation was found between the decrease in NI-BUT value and age, gender, and OSDI (p = 0.08, p = 0.3, and p = 0.2, respectively).

CONCLUSION: The use of face masks throughout the day leads to a significant reduction in NI-BUT, regardless of age, gender, and OSDI score. Prolonged use of face masks should be considered as a risk factor for evaporative dry eye disease.

PMID:35616726 | DOI:10.1007/s00417-022-05709-3

J Physician Assist Educ. 2022 Jun 1;33(2):122-126. doi: 10.1097/JPA.0000000000000429.

ABSTRACT

PURPOSE: Physician assistant (PA) graduates should be prepared to care for patients with substance use disorders. Medication-assisted therapy (MAT) allows PA graduates to provide that care by becoming licensed to prescribe buprenorphine. However, it is unclear how feasible and effective it is to implement online MAT waiver training during PA school. This study examined student knowledge and attitudes after training to assess its impact and perceived value.

METHODS: We conducted a 15-question survey after one class of students completed training during clinical rotations. Students self-reported pre/post change in awareness, knowledge, interest, comfort and confidence, perceived usefulness to practice, and assessed quality using 5-point Likert scale (higher scores = more positive) and narrative responses. Data analysis was performed using the Wilcoxon signed rank test and descriptive statistics. Free text comments were analyzed for themes using constant comparison.

RESULTS: Fifty-five (100%) students completed training within 6 weeks. The survey response rate was 49/55 (89%). Pre-to-post score changes were significant (p < .05) from +0.39 to +1.35 with the greatest changes seen in knowledge (+1.35), comfort (+1.14), awareness (+1.06), and confidence (+1.08); the lowest change was in interest (score change +0.39). Students reported being satisfied with content organization and quality (mean 3.82) and recommended training to colleagues (3.98); 82% reported they would have preferred 3 months to complete training; 46% would have preferred training prior to the start of clinical rotations. Major themes indicated a desire for better preparation and flexibility of platform, with ambivalence about relevance to practice.

CONCLUSION: Online MAT waiver training is feasible and effective. However, students may not be convinced of its relevance to future practice. Faculty should offer adequate preparation and optimize integration into existing curricula.

PMID:35616689 | DOI:10.1097/JPA.0000000000000429

Eur J Trauma Emerg Surg. 2022 May 26. doi: 10.1007/s00068-022-02002-0. Online ahead of print.

ABSTRACT

PURPOSE: Hybrid operating rooms benefit patients with severe trauma but have a prerequisite of significant resources. This paper proposes a practical triage method to determine patients that should enter the hybrid operating room considering a limited availability of medical resources.

METHODS: This retrospective observational study was conducted using the database from the Japan Trauma Data Bank comprising information collected between January 2004 and December 2018. A machine-learning-based triage algorithm was developed using the baseline demographics, injury mechanisms, and vital signs obtained from the database. The analysis dataset comprised information regarding 117,771 trauma patients with an abbreviated injury scale (AIS) > 3. The performance of the proposed model was compared against those of other statistical models [logistic regression and classification and regression tree (CART) models] while considering the status quo entry condition (systolic blood pressure < 90 mmHg).

RESULTS: The proposed trauma hybrid-suite entry algorithm (THETA) outperformed other pre-existing algorithms [precision-recall area under the curve: THETA (0.59), logistic regression model (0.22), and classification and regression tree (0.20)].

CONCLUSION: A machine-learning-based algorithm was developed to triage patient entry into hybrid operating rooms. Although the validation in a prospective multicentre arrangement is warranted, the proposed algorithm could be a potentially useful tool in clinical practice.

PMID:35616704 | DOI:10.1007/s00068-022-02002-0

J Physician Assist Educ. 2022 Jun 1;33(2):78-86. doi: 10.1097/JPA.0000000000000421.

ABSTRACT

PURPOSE: The COVID-19 pandemic significantly impacted United States (US) health professions educational programs. Physician assistant (PA) programs were forced to respond to rapidly changing circumstances early in the pandemic. This study describes the impact that the early phase of the COVID-19 pandemic had on PA programs in the United States.

METHODS: This cross-sectional study is based on data from the COVID-19 Rapid Response Report 1, conducted by the Physician Assistant Education Association in April 2020. The survey sample included 254 US PA program directors with a response rate of 64.2%. Our outcome measures included temporary changes to PA program operations and clinical training, and current and upcoming budget and tuition changes, as well as the impact of the pandemic on faculty and staff employment. We used descriptive statistics to summarize these outcomes, stratified by 4 categories characterizing features of PA programs, including geographical location, academic housing, funding model, and academic health center status.

RESULTS: The COVID-19 pandemic impact on programs varied geographically. A majority of programs reported making numerous temporary changes to their operations. Most programs moved both didactic and clinical education to an online format. Clinical training was temporarily suspended at almost all programs.

CONCLUSIONS: PA programs continued training despite the pandemic. The long-term impact of the pandemic may be the instability of the PA education workforce.

PMID:35616686 | DOI:10.1097/JPA.0000000000000421

Endocr Metab Immune Disord Drug Targets. 2022 May 23. doi: 10.2174/1871530322666220523155452. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Ankle sprains, very common injuries occurred especially during sports activities, are mainly caused by indirect trauma, which influences exaggerated stress exceeding the strength of stabilization mechanisms. Up to 85% of such injuries result from a sudden flexion and inversion of the foot. In this study, we analyzed the effectiveness of the platform Pro-kin, an innovative system that has given us the possibility to combine the functionality of the older proprioceptive boards with very accurate software in order to improve and accelerate the recovery after ankle injuries.

METHODS: 30 patients with moderate ankle sprain outcomes in two groups (A and B) were included in this study. Group A was only treated with proprioceptive exercises for 3 weeks, while the group B was trained with the innovative Pro-kin. In both groups, we evaluated VAS scale, the ratio between the number of circumductions performed by the injured foot and the time spent on doing them and the percentage of load among the injured and the healthy foot in statics and dynamics with electronic baropodometry. Our data has been collected at t0 (beginning of study), t1(one week later), t2 (two weeks later), t3 (one month later), t4 (two months later), and then analyzed by the two-way analysis of variance (2-way ANOVA) test.

RESULTS: At t0 no statistical differences of pain in the 2 groups (3.3 and 3.4); the values were similar, as well as at time t1, t2, t3 and t4. Therefore we deduce that Pro-kin treatment is not painful. The number of circumductions performed was definitely better in B group since the first week; for the A group the values considerably increased only at t3 (one month later). Comparing the load percentages on two feet detected by the electronic baropodometer in statics and in dynamics, we deduced that the patients of A group tend to lean mostly on the healthy foot than B group.

CONCLUSIONS: This study demonstrates that new technological resources (such as Pro-kin) may be helpful to improve and speed up the recovery of ankle sprain in athletes.

PMID:35616674 | DOI:10.2174/1871530322666220523155452

Endocr Metab Immune Disord Drug Targets. 2022 May 23. doi: 10.2174/1871530322666220523114806. Online ahead of print.

ABSTRACT

BACKGROUND: Diabetes Mellitus (DM) is considered the fourth leading cause of death in Palestine, with a prevalence of 9.1% in patients aged 20-79 years, and is predicted to increase to 20.6% by 2020.

AIMS: This study aims to estimate DM costs, compare DM total health care cost among patient characteristics and DM management (e.g. Anti-diabetic medications and alternative medicine), as well as assess MA and its predictors including patient characteristics, DM management, alternative medicine use, and DM costs.

METHODS: A cross-sectional study was conducted for the past one year among 479 diabetic patients, selected by convenience sampling and snowball sampling methods via electronic post of an online questionnaire including a web link to the questionnaire page in a Google Form via email or public social media pages and applications. Data on patients’ socio-demographic and clinical characteristics, medication profile, use of medicinal plants as alternative medicine, costs, and Medication Adherence (MA) were collected. The Statistical Package for Social Sciences (SPSS v. 25) was used to perform a descriptive, Kolmogorov-Smirnov test, univariate analysis, Mann-Whitney or Kruskal-Wallis test, multiple linear regression, binary logistic regression, and multiple logistic regression analysis. A P value < 0.05 was considered statistically significant.

RESULTS: More than half of the participants were male and living in villages (50.7%, 59.1%, respectively). Approximately 51.4% received Oral Hypoglycemic Drugs (OHDs) and only 16.1% received insulin. The participants receiving ≤3 medications daily acquired the highest percentage (55.7%), and less than half received medicinal plants as an alternative medicine for the management of DM. The estimated total DM health care cost per 1 year incurred by patients and family members was Israeli Shekel 988,276 (US Dollar 307,590). More than half of the participants were considered adherent with the Eight-Item Morisky Medication Adherence Scale (MMAS-8) score ≥6. It is noteworthy that the use of alternative medicine was significantly associated with total health care cost and MA. Furthermore, DM duration was significantly associated with MA. These are results worth taking into consideration.

CONCLUSION: This study reflects the need for strengthening the patient-health care professionals’ relationship, and to enhance the role of preventive education, and the importance of awareness about MA, DSCMBs, and the use of alternative medicine based on evidence-based strategies to improve MA, glycemic control, meanwhile reducing the costs incurred by patients and family members.

PMID:35616669 | DOI:10.2174/1871530322666220523114806

Ann Neurol. 2022 May 26. doi: 10.1002/ana.26423. Online ahead of print.

ABSTRACT

OBJECTIVE: Glycine encephalopathy, also known as nonketotic hyperglycinemia (NKH), is an inherited neurometabolic disorder with variable clinical course and severity, ranging from infantile epileptic encephalopathy to psychiatric disorders. A precise phenotypic characterization and an evaluation of predictive approaches are needed.

METHODS: Longitudinal clinical and biochemical data of 25 individuals with NKH from the patient registry of International Working Group on Neurotransmitter related Disorders were studied with in silico analyses, pathogenicity scores and molecular modeling of GLDC and AMT variants.

RESULTS: Symptom onset (p<0_· 01) and diagnosis occur earlier in life in severe NKH (p<0_· 01). Presenting symptoms affect the age at diagnosis. Psychiatric problems occur predominantly in attenuated NKH. Onset-age ≥3 months (66% specificity, 100% sensitivity, AUC = 0·87) and cerebrospinal fluid (CSF)/plasma glycine ratio ≤0_· 09 (57% specificity, 100% sensitivity, AUC = 0·88) are sensitive indicators for attenuated NKH while CSF glycine concentration ≥116_· 5 μmol/L (100% specificity, 93% sensitivity, AUC = 0·97) and CSF/plasma glycine ratio ≥0_· 15 (100% specificity, 64% sensitivity, AUC = 0·88) are specific for severe forms. A ratio threshold of 0_· 128 discriminates the overlapping range. We present ten new GLDC variants. Two mild variants resulted in attenuated, while two severe variants or one mild and one severe variant lead to severe phenotype. Based on clinical, biochemical and genetic parameter we propose a severity prediction model.

INTERPRETATION: This study widens the phenotypic spectrum of attenuated NKH and expands the number of pathogenic variants. The multiparametric approach provides a promising tool to predict disease severity, helping to improve clinical management strategies. This article is protected by copyright. All rights reserved.

PMID:35616651 | DOI:10.1002/ana.26423

Br J Radiol. 2022 May 26:20211402. doi: 10.1259/bjr.20211402. Online ahead of print.

ABSTRACT

OBJECTIVES: Accurate image registration is vital in cervical cancer where changes in both planning target volume (PTV) and organs at risk (OAR) can make decisions regarding image registration complicated. This work aims to determine the impact of a dedicated educational tool compared with experience gained in MR guided radiotherapy (MRgRT).

METHODS: Ten therapeutic radiographers acted as observers and were split into two groups based on previous experience with MRgRT and Monaco treatment planning system. Three CBCT- CT, three MR-CT and two MR-MR registrations were completed per patient by each observer. Observers recorded translations, time to complete image registration and confidence. Data was collected in two phases; prior to and following the introduction of a cervix registration guide.

RESULTS: No statistically significant differences were noted between imaging modalities. Each group was assessed independently pre and post education, no statistically significant differences were noted in either CBCT-CT or MR-CT imaging. Group one MR-MR imaging showed a statistically significant reduction in inter-observer variability (p=0.04), in group two, the result was not statistically significant (p=0.06). Statistically significant increases in confidence were seen in all three modalities (p≤0.05).

CONCLUSIONS: At our institution radiographers consistently registered images across three different imaging modalities regardless of their previous experience. The implementation of an image registration guide had limited impact on inter and intra-observer variability. Radiographers’ confidence showed statistically significant improvements following the use of the registration manual.

ADVANCES IN KNOWLEDGE: This work helps evaluate training methods for novel roles that are developing in MRgRT.

PMID:35616660 | DOI:10.1259/bjr.20211402

J Am Chem Soc. 2022 May 26. doi: 10.1021/jacs.2c03599. Online ahead of print.

ABSTRACT

The aggregation of Aβ42 is a hallmark of Alzheimer’s disease. It is still not known what the biochemical changes are inside a cell which will eventually lead to Aβ42 aggregation. Thermogenesis has been associated with cellular stress, the latter of which may promote aggregation. We perform intracellular thermometry measurements using fluorescent polymeric thermometers to show that Aβ42 aggregation in live cells leads to an increase in cell-averaged temperatures. This rise in temperature is mitigated upon treatment with an aggregation inhibitor of Aβ42 and is independent of mitochondrial damage that can otherwise lead to thermogenesis. With this, we present a diagnostic assay which could be used to screen small-molecule inhibitors to amyloid proteins in physiologically relevant settings. To interpret our experimental observations and motivate the development of future models, we perform classical molecular dynamics of model Aβ peptides to examine the factors that hinder thermal dissipation. We observe that this is controlled by the presence of ions in its surrounding environment, the morphology of the amyloid peptides, and the extent of its hydrogen-bonding interactions with water. We show that aggregation and heat retention by Aβ peptides are favored under intracellular-mimicking ionic conditions, which could potentially promote thermogenesis. The latter will, in turn, trigger further nucleation events that accelerate disease progression.

PMID:35616634 | DOI:10.1021/jacs.2c03599

Public Health Nutr. 2022 May 26:1-27. doi: 10.1017/S1368980022001252. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the association between remittances and food security in Bangladesh, controlling for other key factors.

DESIGN: The secondary data analysis was performed on the most recent (2016) nationally representative Household Income and Expenditure Survey. We used logistic regression models to measure the association between food security of the household and remittances received. The household food security was measured based on expenditure on food items and the energy intake of the household members. The key explanatory variables included the receipt of remittances by the household and household-level socioeconomic characteristics.

SETTING: Bangladesh.

PARTICIPANTS: 45,977 households across 7 divisions of Bangladesh.

RESULTS: Findings suggested that remittances have a significant positive effect on food security. Further, the households with female heads were significantly more likely to be food insecure. The wealth status and geographical locations were significantly associated with food security status in Bangladesh.

CONCLUSIONS: The findings highlight the importance of considering remittance as one of the key factors while stakeholders implement nutritional interventions in Bangladesh and other low-income settings. Future research should consider this as an important determinant while further examining food security in such settings.

PMID:35616088 | DOI:10.1017/S1368980022001252