Tag: pubmed

Clin Transl Sci. 2022 Jul 8. doi: 10.1111/cts.13369. Online ahead of print.

ABSTRACT

Coronavirus disease 2019 (Covid-19) is associated with endothelial dysfunction. Pharmacologically targeting the different mechanisms of endothelial dysfunction may improve clinical outcomes and lead to reduced morbidity and mortality. In this pilot, double-blind, placebo-controlled, randomized clinical trial we assigned patients who were admitted to the hospital with mild, moderate, or severe COVID-19 infection to receive, on top of optimal medical therapy, either an endothelial protocol consisting of (Nicorandil, L-arginine, Folate, Nebivolol, and Atorvastatin) or placebo for up to 14 days. The primary outcome was time to recovery, measured by an 8 category ordinal scale and defined by the time to being discharged from the hospital or hospitalized for infection-control or other nonmedical reasons. Secondary outcomes included the composite outcome of ICU admission or the need for mechanical ventilation, all-cause mortality, and the occurrence of side effects. Of 42 randomized patients, 37 were included in the primary analysis. The mean age of the patients was 57 years; the mean BMI of study participants was 29.14. History of hypertension was present in 27% of the patients, obesity in 45%, and Diabetes Mellitus in 21.6%. The median(Interquartile range) time to recovery was not significantly different between the endothelial protocol group (6 [4-12] days) and the placebo group (6 [5-8]days)(p-value = 0.854). Furthermore, there were no statistically significant differences in the need for mechanical ventilation or ICU admission, all-cause mortality, and the occurrence of side effects between the endothelial protocol group and the placebo group. Among patients hospitalized with mild, moderate, or severe COVID-19 infection, targeting endothelial dysfunction by administering Nicorandil, L-arginine, Folate, Nebivolol, and Atorvastatin on top of optimal medical therapy did not decrease time to recovery. Based on this study findings, targeting endothelial dysfucntion did not result in a clinically significant improvement in outcome and as such larger trials targeting this pathway are not recommended.

PMID:35808843 | DOI:10.1111/cts.13369

J Int Med Res. 2022 Jul;50(7):3000605221105344. doi: 10.1177/03000605221105344.

ABSTRACT

OBJECTIVE: Chromodomain helicase DNA-binding 5 (CHD5) acts as a tumor suppressor gene in some cancers. CHD5 expression levels may affect an individual’s susceptibility to hepatocellular carcinoma (HCC). This study aimed to evaluate the methylation pattern of the CHD5 promoter region and the gene’s corresponding mRNA expression in HCC patients compared with healthy individuals.

METHODS: In this case-control study, CHD5 mRNA gene expression levels and DNA methylation patterns were analyzed in 81 HCC patients and 90 healthy individuals by quantitative reverse transcription polymerase chain reaction and methylation-specific polymerase chain reaction, respectively.

RESULTS: The CHD5 gene was hypermethylated in 61.8% of the HCC patients and 54.4% of the controls, and this difference was statistically significant. The CHD5 mRNA expression levels were significantly lower in the HCC patient group.

CONCLUSIONS: Hypermethylation of the CHD5 promoter region may significantly lower the expression of this gene, affecting the incidence and severity of HCC. The methylation status of CHD5 can also be further studied as a prognostic factor in HCC.

PMID:35808817 | DOI:10.1177/03000605221105344

J Healthc Manag. 2022 Jul 1;67(4):266-282. doi: 10.1097/JHM-D-21-00045.

ABSTRACT

GOAL: The national Baldrige program has supported performance excellence in healthcare since 1999. Previous studies have compared the performance of Baldrige hospital recipients to nonrecipients. This study, however, sought to address the question of whether the mere pursuit of the Baldrige award provides value.

METHODS: This study used propensity score matching with linear and quantile regression techniques to understand the impact of hospitals applying the Baldrige Excellence Framework across a comprehensive set of standardized industry performance measures, regardless of award recognition.

PRINCIPAL FINDINGS: The analysis demonstrated that Baldrige applicants outperformed non-Baldrige applicants in select operational measures of efficiency (such as inpatient average length of stay), patient experience, and financial measures (including return on net assets, days in accounts receivable, and expenses as a percentage of patient revenues). However, there was no statistically significant difference in clinical performance between Baldrige applicants and nonapplicants.

PRACTICAL APPLICATIONS: The findings from this study suggest that hospital leaders can realize significant gains with select operational and financial measures without compromising clinical outcomes when applying the Baldrige Excellence Framework to their organizations.

PMID:35802928 | DOI:10.1097/JHM-D-21-00045

Otol Neurotol. 2022 Jul 6. doi: 10.1097/MAO.0000000000003576. Online ahead of print.

ABSTRACT

OBJECTIVE: Comparison of outcomes and billing costs of patients treated at our institution using transmastoid (TM), middle cranial fossa (MCF), and combined approaches for repair of otogenic cerebrospinal fluid (CSF) leaks and encephaloceles.

STUDY DESIGN: Retrospective cohort review.

SETTING: Tertiary-care hospital.

PATIENTS: Seventy-seven cases of otogenic CSF leaks or encephaloceles.

INTERVENTIONS: Surgical repair of an otogenic encephalocele or CSF leak using either a TM, MCF, or combined approach.

MAIN OUTCOME MEASURES: Success of repair, length of operation, cost of operating room materials, postoperative need for intensive care, and postoperative length of stay.

RESULTS: Forty cases (52%) were performed by the TM approach, 27 (35%) by MCF, and 10 (13%) by combined TM/MCF. Mean length of stay was not statistically different amongst TM patients (2.1 d), MCF patients (3.3 d), and combined TM/MCF patients (3.70; p = 0.112). Only 3/40 TM cases required intensive care during their admission while all MCF and combined TM/MCF approach cases were admitted to the intensive care unit for at least one night (p < 0.001). On follow-up, CSF leak recurred in 3/77 (4%) cases: 3/27 (11%) MCF, 0/40 TM, and 0/10 combined TM/MCF patients (p = 0.056). The mean cost of operating room materials charged to the patient was significantly greater in the MCF group ($9,883) than the TM group ($3,748; p = 0.001).

CONCLUSIONS: In carefully selected patients, the TM approach is an effective and less costly alternative to MCF approaches for repair of otogenic CSF leaks and encephaloceles.

PMID:35802896 | DOI:10.1097/MAO.0000000000003576

Nano Lett. 2022 Jul 8. doi: 10.1021/acs.nanolett.2c01473. Online ahead of print.

ABSTRACT

Single-walled carbon nanotubes (SWCNT) have long attracted attention due to their distinct physical properties, depending on their chiral structures (chiralities). Clarifying their growth mechanism is important toward perfect chirality-controlled bulk synthesis. Although a correlation between the chirality distribution and the carbon atom configuration at an open tube edge has been predicted theoretically, lack of sufficient statistical data on metallic and semiconducting SWCNTs prohibited its verification. Here, we report statistical verification of the chirality distribution of 413 as-grown individual air-suspended SWCNTs with a length of over 20 μm using broadband Rayleigh spectroscopy. After excluding the impact of the difference in the number of possible SWCNT structures per chiral angle interval, the abundance profile with chiral angle exhibits an increasing trend with a distinct anomaly at a chiral angle of approximately 20°. These results are well explained considering the growth rate depending on armchair-shaped site configurations at the catalyst-nanotube interface.

PMID:35802861 | DOI:10.1021/acs.nanolett.2c01473

J Neurosci Nurs. 2022 Jun 30. doi: 10.1097/JNN.0000000000000667. Online ahead of print.

ABSTRACT

AIM: The purpose of this study was to explore the perceived value of certification among those with a neuroscience or stroke nursing certification. METHODS: The Perceived Value of Certification Tool-12 (PVCT-12) consists of 12 value statements related to the benefits of certification, using a 4-point Likert scale ranging from strongly disagree to strongly agree. Descriptive statistics were used to determine the percentage of agreement among respondents with each of the PVCT-12 items. A generalized linear model approach was then used to estimate the associations between age, sex, race, experience, certification, highest degree earned, primary responsibility, and primary work setting with intrinsic and extrinsic values. An exploratory factor analysis was performed to identify factors on which related variables were found. RESULTS: The 632 certificants were predominantly female (90%) with a mean age of 54 years. Approximately 80% were White, followed by Asian (11%), Hispanic (4%), and Black (3%). Certification included certified neuroscience registered nurse (34%), stroke certified registered nurse (47%), or both (20%). Approximately 57% of the certificants work in critical care/medical-surgical units. Work setting included academic (46%) and community (42%). Responses indicated lower levels of agreement with the value statements regarding certification challenges, professional autonomy, being listened to, and monetary gain. Those in administration had statistically significant higher intrinsic and extrinsic value scores (P = .005) as compared with those in nonadministrative roles. There was no significant difference on perceived intrinsic or extrinsic values for those who work in an academic environment versus those who work in a community environment (P = .25). After factor analysis, the PVCT-12 was found to have 3 factors that accounted for 53.4% of the total variation in the data: recognition of specialization, personal achievement, and professional accomplishment. CONCLUSION: The PVCT-12 incorporated a Likert-type scale to provide levels of agreement for intrinsic and extrinsic values among stroke certified registered nurses and certified neuroscience registered nurses. To complement these findings, further research using open-ended questions is needed to improve our understanding of participant responses regarding complex values such as “autonomy” and the “extent of being listened to.”

PMID:35802890 | DOI:10.1097/JNN.0000000000000667

Dent Traumatol. 2022 Jul 8. doi: 10.1111/edt.12775. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: No studies have characterized the morbidity and mortality of maxillary & malar fractures on a national scale. The aim of this study was to examine the risk factors for mortality in pediatric patients who had sustained maxillary and malar fractures by using a national pediatric hospital inpatient care database.

MATERIALS AND METHODS: This retrospective cohort study was conducted using the Kids’ Inpatient Database (KID). The primary predictor variable was the cause of injury. The primary outcome variable was mortality rate. Additional predictor variables included age, gender, race, income, payer information, year and place of injury, number of facial fractures, concomitant facial fractures, other fractures of the body, and intracranial/internal organ injury. Univariate and multivariate regression models were performed to assess risk factors for mortality. Statistical significance was set to a p-value <.05.

RESULTS: A total of 5859 patients met the inclusion criteria. The most common age group was 13-17 years of age (n = 3816, 65.1%). Motor vehicle accidents were the most common mechanism of injury (n = 2172, 37.1%). The presence of cranial vault (OR = 2.81, p = .017), skull base (OR = 2.72, p < .001), and vertebral column fractures (OR = 2.13, p = .016), as well as sub-arachnoid hemorrhage (OR = 4.75, p = .005), traumatic pneumothorax/hemothorax (OR = 2.16, p = .015), and heart/lung injury (OR = 3.37, p < .001) were each independently associated with increased odds of mortality.

CONCLUSIONS: Patients in their late teens most commonly sustained malar and maxillary fractures, likely due to general trends in craniomaxillofacial development. The presence of other fractures located in close proximity to the mid-face increased the risk of mortality among pediatric patients with malar and maxillary fractures. This may be explained by the anatomical approximation of the mid-face to vital neurovascular structures of the head, which, when damaged, may prove fatal.

PMID:35802839 | DOI:10.1111/edt.12775

JCO Clin Cancer Inform. 2022 Jun;6:e2200019. doi: 10.1200/CCI.22.00019.

ABSTRACT

PURPOSE: For real-world evidence, it is convenient to use routinely collected data from the electronic medical record (EMR) to measure survival outcomes. However, patients can become lost to follow-up, causing incomplete data and biased survival time estimates. We quantified this issue for patients with metastatic cancer seen in an academic health system by comparing survival estimates from EMR data only and from EMR data combined with high-quality cancer registry data.

MATERIALS AND METHODS: Patients diagnosed with metastatic cancer from 2008 to 2014 were included in this retrospective study. Patients who were diagnosed with cancer or received their initial treatment within our system were included in the institutional cancer registry and this study. Overall survival was calculated using the Kaplan-Meier method. Survival curves were generated in two ways: using EMR follow-up data alone and using EMR data supplemented with data from the Stanford Cancer Registry/California Cancer Registry.

RESULTS: Four thousand seventy-seven patients were included. The median follow-up using EMR + Cancer Registry data was 19.9 months, and the median follow-up in surviving patients was 67.6 months. There were 1,301 deaths recorded in the EMR and 3,140 deaths recorded in the Cancer Registry. The median overall survival from the date of cancer diagnosis using EMR data was 58.7 months (95% CI, 54.2 to 63.2); using EMR + Cancer Registry data, it was 20.8 months (95% CI, 19.6 to 22.3). A similar pattern was seen using the date of first systemic therapy or date of first hospital admission as the baseline date.

CONCLUSION: Using EMR data alone, survival time was overestimated compared with EMR + Cancer Registry data.

PMID:35802836 | DOI:10.1200/CCI.22.00019

Ann Am Thorac Soc. 2022 Jul 8. doi: 10.1513/AnnalsATS.202206-544LE. Online ahead of print.

NO ABSTRACT

PMID:35802823 | DOI:10.1513/AnnalsATS.202206-544LE

J Orthop Sports Phys Ther. 2022 Jul 8:1-29. doi: 10.2519/jospt.2022.10989. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the effectiveness of patient education with ‘myths and facts’ versus ‘facts only’ on recall of back pain information and fear-avoidance beliefs in patients with chronic low back pain (LBP).

DESIGN: Randomized Study Within A Trial (SWAT).

METHODS: 152 participants with chronic LBP were included. Participants allocated to the ‘facts only’ group received an information sheet with six low back pain facts, whereas those allocated to the ‘myths and facts’ group received the same information sheet, with each myth refuted by its respective fact. The primary outcome was ‘correct recall’ of back pain facts, and the secondary outcome was ‘physical activity component’ of the Fear-avoidance Avoidance Beliefs Questionnaire (FABQ-pa), two weeks after the provision of the information sheet.

RESULTS: There was no evidence of a difference in the proportion of participants with correct recall between ‘myths and facts’ and ‘facts only’ groups (OR 0.98, 95% CI: 0.48, 1.99) and no significant difference in FABQ-pa mean scores between groups (-1.58, 95% CI: -3.77, 0.61). Sensitivity analyses adjusted for prognostic factors showed no difference in information recall but a larger difference in FABQ-pa score (-2.3, 95% CI: – 4.56, -0.04).

CONCLUSIONS: We found no overall difference in recall of back pain information for patients provided ‘myths and facts’ compared with ‘facts only’ and a slight reduction in fear-avoidance beliefs for physical activity using ‘myths and facts’ compared to ‘facts only’, but the meaningfulness of this result is uncertain.

PMID:35802818 | DOI:10.2519/jospt.2022.10989