Tag: pubmed

BMC Health Serv Res. 2022 Sep 22;22(1):1192. doi: 10.1186/s12913-022-08582-2.

ABSTRACT

BACKGROUND: In the first phase of the COVID-19 pandemic, strong measures were taken to avoid anticipated pressure on health care, and this involved new priorities between patient groups and changing working conditions for clinical personnel. We studied how doctors experienced this situation. Our focus was their knowledge about and adherence to general and COVID-19 specific guidelines and regulations on priority setting, and whether actual priorities were considered acceptable.

METHODS: In December 2020, 2 316 members of a representative panel of doctors practicing in Norway received a questionnaire. The questions were designed to consider a set of hypotheses about priority setting and guidelines. The focus was on the period between March and December 2020. Responses were analyzed with descriptive statistics and regression analyses.

RESULTS: In total, 1 617 (70%) responded. A majority were familiar with the priority criteria, though not the legislation on priority setting. A majority had not used guidelines for priority setting in the first period of the pandemic. 60.5% reported that some of their patients were deprioritized for treatment. Of these, 47.5% considered it medically indefensible to some/a large extent. Although general practitioners (GPs) and hospital doctors experienced deprioritizations equally often, more GPs considered it medically indefensible. More doctors in managerial positions were familiar with the guidelines.

CONCLUSIONS: Most doctors did not use priority guidelines in this period. They experienced, however, that some of their patients were deprioritized, which was considered medically indefensible by many. This might be explained by a negative reaction to the externally imposed requirements for rationing, while observing that vulnerable patients were deprioritized. Another interpretation is that they judged the rationing to have gone too far, or that they found it hard to accept rationing of care in general. Priority guidelines can be useful measures for securing fair and reasonable priorities. However, if the priority setting in clinical practice is to proceed in accordance with priority-setting principles and guidelines, the guidelines must be translated into a clinically relevant context and doctors’ familiarity with them must improve.

PMID:36138400 | DOI:10.1186/s12913-022-08582-2

BMC Oral Health. 2022 Sep 22;22(1):425. doi: 10.1186/s12903-022-02454-1.

ABSTRACT

BACKGROUND: The administration of local anesthesia (LA) in dental practice requires an injection which is the leading cause of patients’ fear and anxiety. Computer-controlled local anesthetic injector, designed to reduce the pain of performing local anesthesia by controlling the speed of injection. This single-blind randomised control trial aimed to compare the pain perception after computer-controlled local anesthesia (CCLA) and conventional LA.

METHODS: Dental students were both test and operator group versus an experienced dentist as additional operator of the LA. Data were collected regarding gender, age, medical condition, smoking habits. Additionally, operator feedback about the handling, pain at insertion and during infiltration, excitement (Dental Anxiety Scale), and complications were assessed.

RESULTS: Out of the 60 included participants, the majority were females (n = 41; 68.3%), medically healthy (n = 54; 90%), and did not receive medications (n = 54; 90%). While the participating students administered 62 (51.7%) injections, the experienced dentist administered 58 (48.3%) injections. The difference in pain perception on puncture between CCLA and conventional injections was not statistically significant (Sig. = 0.285); however, pain perception during injection was significantly different (Sig. = 0.029) between CCLA (1.65 ± 1.93) and conventional injections (2.49 ± 2.31).

CONCLUSION: The professional experience influenced the pain perception while applying the LA. CCLA did not reduce pain on puncture significantly; however, pain perception during the injection was significantly reduced in the case of using CCLA devices compared to the conventional syringe.

PMID:36138388 | DOI:10.1186/s12903-022-02454-1

BMC Palliat Care. 2022 Sep 22;21(1):165. doi: 10.1186/s12904-022-01052-w.

ABSTRACT

BACKGROUND: Advance care planning (ACP) and goals of care discussions are important instruments that enable respect for patient autonomy, especially in patients with a life-threatening disease, such as cancer. Despite their well-established benefits, ACP and goals of care discussions are still not frequently performed in clinical oncology practice. Understanding the barriers to this topic is the first step toward developing future interventions that are more likely to improve professional practice and patient satisfaction with care.

AIM: To explore Brazilian oncologists’ barriers to discuss goals of care and advance care planning.

METHODS: A cross-sectional study was developed to identify Brazilian oncologists’ barriers to discussing goals of care and ACP. The Decide-Oncology questionnaire was used to identify the importance of these barriers according to oncologists’ perceptions. Participants were asked to rank the importance of various barriers to discussing goals of care, ranging from 1 (extremely unimportant) to 7 (extremely important). A quantitative analysis using descriptive statistics was used, including median and interquartile intervals and a qualitative analysis based on Bardin content analysis of the two open questions.

RESULTS: Sixty-six oncologists participated in this study. Most of them perceived the patient and family’s related barriers as the most important, such as patients’ difficulty in understanding their diagnosis and accepting their prognosis. Physician and external related factors, such as lack of training and lack of time for this conversation, were also described as important barriers. Participants with formal training regarding goals of care communication and with experience in palliative care perceived the lack of patients’ advanced directives as a significant barrier and manifested more willingness to participate in decision-making about goals of care. The lack of access and of support for referral to palliative care was also considered a significant barrier for ACP and goals of care discussion.

CONCLUSION: The identification of barriers that limit the discussion of ACP and early palliative care referrals can certainly help to prioritise the next steps for future studies aimed at improving ACP and helping clinicians to better support patients through shared decision-making based on the patient’s values and experiences.

PMID:36138380 | DOI:10.1186/s12904-022-01052-w

BMC Neurol. 2022 Sep 22;22(1):360. doi: 10.1186/s12883-022-02876-y.

ABSTRACT

BACKGROUND AND AIM: Stroke patients face various challenges that affect their self-efficacy. The purpose of this study is to evaluate the effect of a self-management program on the self-efficacy of patients with Stroke.

METHODS AND MATERIALS: This study is a clinical trial, in which 72 patients with stroke participated in this study. They were selected based on the convenience sampling method and assigned to either intervention or control group (36 patients in each group) randomly. The intervention group received 5A based self-management program for 6 weeks (in-person and off-site) and the control group received only routine care includes stroke training booklets and post-discharge care training by the ward nurse. Data were collected through demographic and jones self-efficacy questionnaires, before, immediately after, and 3 months after interventions in both groups and were analyzed with descriptive and analytical statistics using SPSS software (with independent t-test, Chi-square, Fisher and analysis of variance with repeated measures with a significance level of 0.05).

RESULTS: Before interventions, the two study groups had no statistically significant difference regarding demographic variables and the mean score of self-efficacy. Immediately and 3 months after interventions, the mean score and mean changes of self-efficacy score in the intervention group were significantly greater than in the control group(p < 0.001).

CONCLUSION: The results of the present study show the appropriate effect of self-management program on self-efficacy of stroke patients. These results can be used by different members of healthcare teams to improve patients’ self-efficacy.

TRIAL REGISTRATION: This study is registered by Iranian Registry of Clinical Trials with decree code: IRCT20190712044181N2 (registration date: 05-11-2019).

PMID:36138361 | DOI:10.1186/s12883-022-02876-y

BMC Public Health. 2022 Sep 22;22(1):1804. doi: 10.1186/s12889-022-14113-9.

ABSTRACT

BACKGROUND: Women living with HIV (WLWH) experience numerous social and structural barriers to stable housing, with substantial implications for access to health care services. This study is the first to apply the Canadian Definition of Homelessness (CDOH), an inclusive national guideline, to investigate the prevalence and correlates of housing status among WLWH in Metro Vancouver, Canada.

METHODS: Our study utilized data from a longitudinal open cohort of cisgender and trans WLWH aged 14 years and older, in 2010-2019. Cross-sectional descriptive statistics of the prevalence of housing status and other social and structural variables were summarized for the baseline visits. Bivariate and multivariable logistic regression analyses were conducted using generalized linear mixed models (GLMM) for repeated measures to investigate the relationship between social and structural correlates and housing status among WLWH.

RESULTS: The study included 336 participants with 1930 observations over 9 years. Housing status derived from CDOH included four categories: unsheltered, unstable, supportive housing, and stable housing (reference). Evidence suggested high levels of precarious housing, with 24% of participants reporting being unsheltered, 47% reporting unstable housing, 11.9% reporting supportive housing, and 16.4% reporting stable housing in the last six months at baseline. According to the multivariable models, living in the Downtown Eastside (DTES) neighbourhood of Metro Vancouver, hospitalization, physical/sexual violence, and stimulant use were associated with being unsheltered, compared to stable housing; DTES residence, hospitalization, and physical/sexual violence were associated with unstable housing; DTES residence and stimulant use were associated with living in supportive housing.

CONCLUSION: Complex social-structural inequities are associated with housing instability among WLWH. In addition to meeting basic needs for living, to facilitate access to housing among WLWH, housing options that are gender-responsive and gender-inclusive and include trauma- and violence-informed principles, low-barrier requirements, and strong connections with supportive harm reduction services are critical.

PMID:36138356 | DOI:10.1186/s12889-022-14113-9

BMC Neurol. 2022 Sep 22;22(1):367. doi: 10.1186/s12883-022-02899-5.

ABSTRACT

BACKGROUND: A thorough understanding of the factors that influence patient survival in Parkinson’s disease (PD) will aid in prognosis prediction and provide a new direction for disease modification treatment. Currently, there are no standardized mortality ratio (SMR) data for PD patients in the northern Chinese mainland. The main focus of this study was to determine which factors in the prospectively collected baseline characteristics can affect the survival of PD patients. In addition, for the first time, we investigated the SMR of PD patients in northern China.

METHODS: Between 2009 and 2012, 218 PD patients were continuously recruited from the movement disorder clinic of the First Affiliated Hospital of Dalian Medical University and followed up until death or May 31, 2021. The prespecified prognostic variables were demographics, clinical features, lifestyle factors, and drug dose prospectively collected at baseline. To determine the independent predictors of survival during follow-up, the Cox proportional hazards model was used. Kaplan-Meier analysis was applied to estimate the overall survival curve and to compare survival between layers based on statistically significant predictors. The SMR of this northern Chinese mainland PD cohort was calculated.

RESULTS: After a mean follow-up of 9.58 ± 2.27 years, 50 patients (22.90%) died. Factors that could individually predict shortened survival during follow-up included older age at onset (hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.06-1.15), Hoehn and Yahr (H&Y) stage ≥ 3 (HR 9.36, 95% CI 2.82-31.03) and severe cognitive impairment (HR 6.18, 95% CI 2.75-13.88). Univariate Cox regression revealed that a certain amount of physical activity was associated with better survival (HR 0.41, 95% CI 0.22-0.74), while fatigue was associated with an increased risk of death (HR 2.54, 95% CI 1.37-4.70). The overall SMR was 1.32 (95% CI 0.98-1.74).

CONCLUSIONS: Older age at onset, higher baseline H&Y stage, and severe cognitive impairment have a negative impact on survival. The 10-year survival of PD patients is not significantly different from that of the general population in China.

PMID:36138355 | DOI:10.1186/s12883-022-02899-5

BMC Oral Health. 2022 Sep 22;22(1):421. doi: 10.1186/s12903-022-02442-5.

ABSTRACT

BACKGROUND: A change in how a dentist looks may affect the child’s anxiety in the dental office. This study compared the effect of conventional facial PPE versus extra PPE as reusable respirators; on the preoperative child’s anxiety in the dental office.

METHODS: Fifty two children were randomly allocated into 4 groups, (1) goggles + surgical mask, and (2) face shield + surgical mask versus (3) half-face respirator and (4) full-face respirator. Each child was communicated with and clinically examined by a dentist wearing the assigned PPE, and then his anxiety was assessed using CFSS-DS. Shapiro-Wilk’s test was used to analyse normality. Kruskal-Wallis test followed by Dunn’s post hoc test with Bonferroni correction test, were used to analyse non-parametric anxiety score data. Correlations between different factors and anxiety scores were analysed using Spearman’s rank-order correlation coefficient.

RESULTS: There were no statistically significant differences in the number of anxious children in each group, boys had significantly higher scores than girls (p < 0.001) For the “Goggles and surgical mask” group and “overall”. There was no significant correlation between age and anxiety scores. Children who didn’t have a previous dental visit had statistically significant higher scores than children with previous experience for “Goggles and surgical mask”, “Face shield and surgical mask “groups and “overall”.

CONCLUSIONS: Half-face and full-face respirators have not affected the child’s preoperative anxiety in the dental office when compared to the conventionally used PPE. Overall, there is an association between gender and previous dental visits, and dental anxiety, however; there is no correlation between child’s age and dental anxiety. Dentists dealing with children should feel free to use reusable respirators, without the risk of affecting children’s anxiety in the dental office. Trial Registration This study was registered on www.

CLINICALTRIALS: gov , ID: NCT05371561 on 12/05/2022.

PMID:36138354 | DOI:10.1186/s12903-022-02442-5

BMC Nephrol. 2022 Sep 23;23(1):319. doi: 10.1186/s12882-022-02942-0.

ABSTRACT

BACKGROUND: Sarcopenia is associated with various adverse outcomes in hemodialysis patients. However, current tools for assessing and diagnosing sarcopenia have limited applicability. In this study, we aimed to develop a simple and reliable nomogram to predict the risk of sarcopenia in hemodialysis patients that could assist physicians identify high-risk patients early.

METHODS: A total of 615 patients undergoing hemodialysis at the First Affiliated Hospital College of Medicine Zhejiang University between March to June 2021 were included. They were randomly divided into either the development cohort (n = 369) or the validation cohort (n = 246). Multivariable logistic regression analysis was used to screen statistically significant variables for constructing the risk prediction nomogram for Sarcopenia. The line plots were drawn to evaluate the effectiveness of the nomogram in three aspects, namely differentiation, calibration, and clinical net benefit, and were further validated by the Bootstrap method.

RESULTS: The study finally included five clinical factors to construct the nomogram, including age, C-reactive protein, serum phosphorus, body mass index, and mid-upper arm muscle circumference, and constructed a nomogram. The area under the ROC curve of the line chart model was 0.869, with a sensitivity and specificity of 77% sensitivity and 83%, the Youden index was 0.60, and the internal verification C-statistic was 0.783.

CONCLUSIONS: This study developed and validated a nomogram model to predict the risk of sarcopenia in hemodialysis patients, which can be used for early identification and timely intervention in high-risk groups.

PMID:36138351 | DOI:10.1186/s12882-022-02942-0

AMB Express. 2022 Sep 22;12(1):124. doi: 10.1186/s13568-022-01464-0.

ABSTRACT

Design of experiment (DOE) is a statistical approach for designing, performing, and interpreting a large set of data with the minimum number of tests. In our previous study, we developed a novel Hsp27 SILEX system for production of recombinant proteins. In the present study, we optimized indirectly the most effective factors including inoculation load, self-induction temperature, and culture media on autoinduction of staphylokinase (SAK) expression using RSM methodology and fluorometry. The expression level of SAK was assayed at different runs after 6 h incubation at 90 rpm. The results indicated all parameters significantly affect the SAK expression level (p < 0.05). The optimum expression condition was obtained with an inoculation load of 0.05, a temperature of 25 °C, and TB culture medium. The analysis of variance with a R² value of 0.91 showed that a quadratic model well described this prediction (p < 0.05). Applying the optimized condition led to an approximately fourfold increase in the SAK expression level (from 1.3 to 5.2 µg/ml). Moreover, the recombinant protein was purified using immobilized metal affinity chromatography and the activity was also confirmed by semi-quantitative caseinolytic method.

PMID:36138332 | DOI:10.1186/s13568-022-01464-0

J Patient Rep Outcomes. 2022 Sep 23;6(1):100. doi: 10.1186/s41687-022-00508-0.

ABSTRACT

BACKGROUND: The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale has demonstrated good internal consistency and responsiveness to changes in clinical status among patients with ankylosing spondylitis (AS). We aimed to further evaluate the psychometric properties of the FACIT-F scale in adult patients with AS.

METHODS: Measurement properties of the FACIT-F scale were evaluated using data from tofacitinib phase 2/3 (NCT01786668/NCT03502616) studies in adult patients with active AS.

RESULTS: Second-order confirmatory factor modeling supported the measurement structure of the FACIT-F scale (Bentler’s comparative fit index ≥ 0.91), and FACIT-F demonstrated excellent internal consistency (Cronbach’s coefficient α ≥ 0.88) and test-retest reliability (Intraclass Correlation Coefficient ≥ 0.75). Correlation coefficients between FACIT-F and other patient-reported outcomes generally exceeded 0.40, supporting convergent validity. Meaningful within-patient change was estimated as 3.1-6.3 for FACIT-F total score, and 1.4-2.8 and 1.7-3.6 for FACIT-F Experience and Impact domain scores, respectively. Large (effect size ≥ 1.17 standard deviation units), statistically significant differences in FACIT-F domain/total scores between ‘no disease activity’ (Patient Global Assessment of Disease Activity [PtGA] = 0) and ‘very active disease’ (PtGA = 10) patient groups supported known-groups validity. Ability to detect change was evidenced by an approximately linear relationship between changes in FACIT-F and PtGA scores.

CONCLUSIONS: FACIT-F is a reliable and valid measure for evaluating fatigue in adult patients with active AS.

TRIAL REGISTRATION: ClinicalTrials.gov; NCT01786668 (registered 6 February 2013, https://clinicaltrials.gov/ct2/show/NCT01786668 ) and NCT03502616 (registered 11 April 2018, https://clinicaltrials.gov/ct2/show/NCT03502616 ).

PMID:36138330 | DOI:10.1186/s41687-022-00508-0