Tag: pubmed

Vopr Kurortol Fizioter Lech Fiz Kult. 2022;99(4):36-42. doi: 10.17116/kurort20229904136.

ABSTRACT

The choice of medical rehabilitation in patients with anal incontinence is impossible without diagnostic data revealing the mechanism of fecal incontinence. The most promising are programs of comprehensive physiotherapeutic rehabilitation based on biofeedback training. The rate of anal incompetence (AI) after hemorrhoidectomy is 1.3-12.5%. However, in addition to the organic cause (surgical trauma), functional disorders of the external sphincter and pelvic floor muscles may contribute to the pathogenesis of anal incontinence, aggravating the incontinence symptoms after surgery. Therefore, these functional disorders should be diagnosed before surgery. However, medical rehabilitation programs for anal incontinence after hemorrhoidectomy are not standardized, and functional outcomes have not been studied.

OBJECTIVE: To evaluate the outcomes of comprehensive rehabilitation in patients with AI after hemorrhoidectomy to improve quality of life after surgery.

MATERIALS AND METHODS: A retrospective study was carried out on 46 patients (mean age 53.8±15.4 years) after hemorrhoidectomy with fecal incontinence, 13 (28.3%) males and 33 (71.7%) females. The main group included 25 patients who received comprehensive rehabilitation, including biofeedback training and tibial neuromodulation (TNM) for 15 days. The control group consisted of 21 patients who received TNM at home also for 15 days. The severity of fecal incontinence was determined using the Wexner score. The functional state of the sphincter before and after surgery was assessed using the anorectal manometry (sphincterometry) (WPM Solar, the Netherlands).

RESULTS: Comprehensive rehabilitation resulted in a statistically significant clinical improvement: a decrease in the Wexner score in both males and females. No significant differences in manometry results were observed: the anal sphincter tone increased by 16.0% in females and 10.6% in males, and contractility increased by 17.7% and 15.1%, respectively. Monotherapy with TNM in control group patients improved tone indices by 8.7% in females and 6.8% in males, and contractility by 6.2 and 5.4%, respectively, which was lower than in the main group.

CONCLUSION: Contraindications to physiotherapeutic procedures based on electrical stimulation, extracorporeal magnetic stimulation, and magnetic translumbosacral neuromodulation determine the only possible choice of medical rehabilitation, which is the combination of biofeedback training and TNM (as superior to TNM monotherapy). If out-patient medical rehabilitation is not feasible, patients are recommended to complement the home course with a specially designed set of exercises for anal incontinence treatment.

PMID:35981340 | DOI:10.17116/kurort20229904136

Vopr Kurortol Fizioter Lech Fiz Kult. 2022;99(4):20-28. doi: 10.17116/kurort20229904120.

ABSTRACT

A promising direction of osteoarthritis (OA) therapy is currently being considered pharmaceutical compositions of Symptomatic Slow Acting Drugs for Osteoarthritis (SYSADOA), which include type II collagen. A clinical observational study was conducted.

OBJECTIVE: To Identify the effect of physical activity complex effects with dietary supplements Cartilox (composition: hydrolyzed type II collagen, hyaluronic acid, boswellia, curcumin, piperine) on the severity of pain syndrome in OA knee and hip joint patients, low back pain (LBP); assessment of the need for the appointment of NSAIDs against the background of taking Cartilox.

MATERIAL AND METHODS: The study included 60 patients aged 35-65 years, with a confirmed diagnosis of knee and hip OA I-II st., LBP with a slight degree of severity of pain syndrome – 4-5 points on a numerical rating scale (NRS). Patients with comorbid diseases: arterial hypertension (AH), type 2 diabetes mellitus (DM-2), hypothyroidism, diseases of the gastrointestinal tract (gastrointestinal tract). By randomization, the patients were divided into two groups: Main group (n=30; 54.36±8.57 years) received a complex effect of non-drug therapy (physical therapy complex) with dietary supplements Cartilox 1 sachet per day during or immediately after meals for 1 month, in combination with non-medical therapy (physical therapy complex). And Control group (n=30; 53.03±16.18 years) used only non-medical therapy (physical therapy complex). In both groups, topical NSAIDs were used «on demand». The patients included in the study had imaging data of the spine and joints. Clinical and neurological examination was used: day 0 (Visit 1), Day 14 (Visit 2), Day 30 (Visit 3) of therapy. The dynamics of the condition was assessed: 10-point NRS of pain assessment (at rest, while walking, palpation), functional status of Oswestry Disability Index (ODI), blood pressure (BP) was measured, the dynamics of biochemical parameters (before and after 30 days) of blood glucose, liver enzymes (AST, ALT), weight indicators, registration of adverse events (AEs). A sub-objective assessment (1 to 5 balls) was given to the patient and the physician.

RESULTS: Against the background of taking Cartilox, a statistically significant decrease in the severity of pain syndrome was noted, an improvement on ODI (to a greater extent in the Main group vs the Control group). In no case has a registered AEs. Changes in the level of biochemical blood parameters (glucose, liver enzymes) and blood pressure levels were not observed. The topical NSAIDs use was observed only in the Control group.

CONCLUSION: The complex effect of physical exertion with dietary supplements Cartilox can be recommended for patients with unexpressed pain syndrome (4-5 points on the NRS) with LBP and knee and hip OA (I-II st.). The absence of changes in the level of biochemical parameters of blood and blood pressure makes it possible to recommend Cartilox to patients with OA and comorbid diseases.

PMID:35981338 | DOI:10.17116/kurort20229904120

Pediatr Emerg Care. 2022 Aug 17. doi: 10.1097/PEC.0000000000002826. Online ahead of print.

ABSTRACT

OBJECTIVE: Infectious diseases, including pneumonia, malaria, and diarrheal diseases, are the leading causes of death in children younger than 5 years worldwide. The vast majority of these deaths occur in resource-limited settings where there is significant variation in the availability and type of human, physical, and infrastructural resources. The ability to identity gaps in healthcare systems that may hinder their ability to deliver care is an important step to determining specific interventions for quality improvement. Our study objective was to develop a comprehensive, digital, open-access health facility survey to assess facility readiness to provide pediatric critical care in resource-limited settings (eg, low- and lower middle-income countries).

METHODS: A literature review of existing facility assessment tools and global guidelines was conducted to generate a database of survey questions. These were then mapped to one of the following 8 domains: hospital statistics, services offered, operational flow, facility infrastructure, staff and training, medicines and equipment, diagnostic capacity, and quality of clinical care. A 2-phase survey was developed and an iterative review process of the survey was undertaken with 12 experts based in low- and middle-income countries. This was built into the REDCap Mobile Application for electronic data capture.

RESULTS: The literature review process yielded 7 facility assessment tools and 7 global guidelines for inclusion. After the iterative review process, the final survey consisted of 11 sections with 457 unique questions in the first phase, “environmental scan,” focusing on the infrastructure, availability, and functionality of resources, and 3 sections with 131 unique questions in the second phase, “observation scan,” focusing on the level of clinical competency.

CONCLUSIONS: A comprehensive 2-phase survey was created to evaluate facility readiness for pediatric critical care. Results will assist hospital administrators and policymakers to determine priority areas for quality improvement, enabling them to implement a Plan-Do-Study-Act cycle to improve care for the critically ill child.

PMID:35981329 | DOI:10.1097/PEC.0000000000002826

Chem Biodivers. 2022 Aug 18. doi: 10.1002/cbdv.202200448. Online ahead of print.

ABSTRACT

Magnolia grandiflora is an aromatic plant widely distributed around the world. In Colombia, and more specifically in Bogotá, M. grandiflora has been introduced as part of urban forestry programs, and their specimens are therefore subjected to several environments. Nevertheless, there are no previous studies on the chemical composition of such plants. Hence, the characterization of the essential oil from 20 specimens of M. grandiflora from Bogotá, Colombia, by GC-MS was carried out here. Two different chemotypes were found. While one was characterized by monoterpenes α-pinene, β-pinene, and limonene, the other contained mainly sesquiterpenes β-elemene, bicyclogermacrene, and germacrene D. Multivariate statistical analyses confirmed their existence and helped to identify variations within and between chemotypes. Furthermore, differential expression of genes encoding the terpene synthases Mg 25 and Mg 17 could arguably be responsible for the characteristic compositions of both chemotypes, as suggested by rational biosynthetic analysis of the most contrasting metabolites.

PMID:35981267 | DOI:10.1002/cbdv.202200448

JMIR Med Inform. 2022 Aug 11. doi: 10.2196/37770. Online ahead of print.

ABSTRACT

BACKGROUND: Triage of textual telemedical queries is a safety-critical task for medical service providers with limited remote health resources. The prioritization of patient queries containing medically severe text is necessary to optimize resource usage and provide care to those with time-sensitive needs.

OBJECTIVE: We aim to evaluate the effectiveness of transfer learning solutions on the task of telemedical triage and provide a thorough error analysis, identifying telemedicine queries which challenge state-of-the-art Natural Language Processing systems. Additionally, we aim to provide a publicly available telemedical query dataset with labels for severity classification for telemedical triage of respiratory issues.

METHODS: We annotate 573 medical queries from three online health platforms: HealthTap.com, Healthcaremagic.com and iCliniq.com. We then evaluate six transfer learning solutions utilizing various textual embedding strategies. Specifically, we first establish a baseline using a lexical classification model with Term Frequency-Inverse Document Frequency (TF-IDF) features. Next, we investigate the effectiveness of Global Vectors for Text Representation (GloVe), a pre-trained word embedding method. We evaluate the performance of GloVe embeddings in the context of Support Vector Machines, Bidirectional Long Short-Term Memory (LSTM) networks, and Hierarchical Attention Networks. Finally we evaluate the performance of contextual text embeddings using transformer-based architectures. Specifically, we evaluate Bidirectional Encoder Representations from Transformers (BERT), Bio+Clinical BERT, and Sentence-BERT (SBERT) on the telemedical triage task.

RESULTS: We find that a simple lexical model achieves an F1 score of 0.865 on the telemedical triage task. GloVe-based models using Support Vector Machines, Hierarchical Attention Networks , and Bidirectional LSTMs achieve a 0.8, 1.5, and 2.1-point increase in F1 score respectively. Transformer-based models such as BERT, Bio+Clinical BERT, and SBERT achieve an F1 score of 0.914, 0.904, 0.917 respectively. The highest performing model, SBERT, provides a statistically significant improvement compared to all GloVe-based and lexical baselines. However, no statistical significance is found when comparing transformer-based models. Furthermore, our error analysis reveals highly-challenging query types, including those with complex negations, temporal relationships, and patient intents. Our analysis highlights various avenues for future works which explicitly model such query challenges.

CONCLUSIONS: We show that state-of-the-art transfer learning techniques work well on the telemedical triage task, providing significant performance increase over lexical models. Additionally, we release a public telemedical triage dataset using labeled questions from online medical Q&A platforms. Data and code from this study can be found on GitHub [1].

PMID:35981230 | DOI:10.2196/37770

Am J Manag Care. 2022 Aug;28(8):390-396. doi: 10.37765/ajmc.2022.89198.

ABSTRACT

OBJECTIVES: To examine changes in plan composition and enrollee experience associated with Medicaid expansion among Medicaid managed care organization (MCO) enrollees.

STUDY DESIGN: Using 2012-2018 Adult Medicaid Consumer Assessment of Healthcare Providers and Systems surveys, we estimated changes in MCO enrollee characteristics and 4 outcomes: having access to needed care, having a personal doctor, having timely access to a checkup, and having timely access to specialty care.

METHODS: We estimated multivariable linear probability models comparing pre- vs postexpansion changes in expansion vs nonexpansion states. The postexpansion period was modeled as an event-study regression to account for changes over time. The coefficient of interest was a Medicaid expansion-by-year term.

RESULTS: Medicaid expansion was associated with statistically significant decreases in the proportion of female enrollees (-8.4 percentage points [PP]; P < .01) and increases in the proportion of enrollees who were aged 55 to 64 years (6.8 PP; P < .01) and were non-Hispanic White (4.4 PP; P < .01). Relative to enrollees in nonexpansion states, MCO enrollees in expansion states were significantly less likely to report access to a personal doctor (-1.6 PP; 95% CI, -3.0 to -0.1 PP) and less likely to report timely access to specialty care (-2.1 PP; 95% CI, -3.4 to -0.8 PP; P < .01) in the first year after expansion. Differences were not statistically significant by the second year post expansion. There were not significant changes in the other 2 outcomes.

CONCLUSIONS: State policy makers may need to account for the role that Medicaid expansion may have in changing Medicaid MCO enrollee composition to prevent unfair penalization on performance metrics.

PMID:35981124 | DOI:10.37765/ajmc.2022.89198

Holist Nurs Pract. 2022 Sep-Oct 01;36(5):E38-E47. doi: 10.1097/HNP.0000000000000544.

ABSTRACT

We set out to implement a pilot mindfulness-based intervention (MBI) to alleviate burnout, stress, anxiety, and depression in nursing and support staff of an oncological intensive care unit. We created an 8-week personalized yoga therapy MBI for nurses and patient care technicians in an oncological intensive care unit. Validated self-report scale tools were used to measure burnout, stress, anxiety, and depression in the intervention and control groups (Institutional Quality Improvement Registry no. 296, 2018). Changes in scores from baseline to postintervention were evaluated between groups. Forty-five staff, 21 in the control group and 24 in the intervention group, participated. Both groups at baseline had low prevalence of stress, anxiety, and depression (13% vs 36.8%, P = .11; 21.7% vs 52.6%, P = .17; 17.4% vs 26.3%, P = .48; respectively). Low rates of high emotional exhaustion, depersonalization, and low professional efficacy were observed for both groups (41.7% vs 35.0%, P = .65; 20.8% vs 15%, P = .71; 58.3% vs 50.0%, P = .58, respectively). Post-MBI, prevalence of depression, anxiety, stress, emotional exhaustion, and depersonalization remained low and similar between both groups. Notwithstanding, professional efficacy scores significantly improved in a between-group comparison (0.063 vs -0.25; P = .0336). We observed that burnout, stress, anxiety, and depression were remarkably low in our study relative to the literature. Implementation of the MBI faced many obstacles and had low compliance during participation. This presumably influenced results and should be addressed prior to any future intervention. Despite this, professional efficacy improved significantly.

TRIAL REGISTRATION: Approved by MD Anderson Cancer Center Quality Improvement Registry (no. 296, 2018).

PMID:35981118 | DOI:10.1097/HNP.0000000000000544

Holist Nurs Pract. 2022 Sep-Oct 01;36(5):268-274. doi: 10.1097/HNP.0000000000000542.

ABSTRACT

This study aimed to determine the effects of sleep hygiene education on sleep quality in liver transplant patients. In the literature, the efficacy of various pharmacological methods for reducing poor sleep quality associated with liver transplant patients and studies on nonpharmacological methods are limited. This study was conducted using a quasiexperimental design with a pre- and posttest, and a control group. When the power analysis was made, a sample size with 5% double-sided significance, 95% confidence interval, and 95% ability to represent the population was calculated to have a total of 100 liver transplant patients. The data were collected using a patient information form, and the Richard Campbell Sleep Quality Questionnaire. In the experimental group, the researcher gave a sleep hygiene training for 1 week. No treatment was performed in the control group. To analyze the data, descriptive statistics, a χ2 test, a t test for dependent groups, and a t test for independent groups were used. According to sleep hygiene training follow-ups after liver transplantation, the mean scores of sleep quality was similarly poor, with a statistical significance in the experimental group compared with the control group in all measurements before and after sleep hygiene training (P < .001). The sleep hygiene training applied to liver transplant patients positively affected and decreased the severity of sleep quality.

PMID:35981111 | DOI:10.1097/HNP.0000000000000542

JMIR Mhealth Uhealth. 2022 Aug 18;10(8):e37290. doi: 10.2196/37290.

ABSTRACT

BACKGROUND: The System Usability Scale (SUS) is a widely used scale that has been used to quantify the usability of many software and hardware products. However, the SUS was not specifically designed to evaluate mobile apps, or in particular digital health apps (DHAs).

OBJECTIVE: The aim of this study was to examine whether the widely used SUS distribution for benchmarking (mean 68, SD 12.5) can be used to reliably assess the usability of DHAs.

METHODS: A search of the literature was performed using the ACM Digital Library, IEEE Xplore, CORE, PubMed, and Google Scholar databases to identify SUS scores related to the usability of DHAs for meta-analysis. This study included papers that published the SUS scores of the evaluated DHAs from 2011 to 2021 to get a 10-year representation. In total, 117 SUS scores for 114 DHAs were identified. R Studio and the R programming language were used to model the DHA SUS distribution, with a 1-sample, 2-tailed t test used to compare this distribution with the standard SUS distribution.

RESULTS: The mean SUS score when all the collected apps were included was 76.64 (SD 15.12); however, this distribution exhibited asymmetrical skewness (-0.52) and was not normally distributed according to Shapiro-Wilk test (P=.002). The mean SUS score for “physical activity” apps was 83.28 (SD 12.39) and drove the skewness. Hence, the mean SUS score for all collected apps excluding “physical activity” apps was 68.05 (SD 14.05). A 1-sample, 2-tailed t test indicated that this health app SUS distribution was not statistically significantly different from the standard SUS distribution (P=.98).

CONCLUSIONS: This study concludes that the SUS and the widely accepted benchmark of a mean SUS score of 68 (SD 12.5) are suitable for evaluating the usability of DHAs. We speculate as to why physical activity apps received higher SUS scores than expected. A template for reporting mean SUS scores to facilitate meta-analysis is proposed, together with future work that could be done to further examine the SUS benchmark scores for DHAs.

PMID:35980732 | DOI:10.2196/37290

JMIR Form Res. 2022 Aug 18;6(8):e37309. doi: 10.2196/37309.

ABSTRACT

BACKGROUND: Social messaging strategies such as SMS text messaging and radio are promising avenues for health promotion and behavior change in low- to middle-income settings. However, evidence of their acceptability, feasibility, and impact in the context of young women’s health and micronutrient deficiencies is lacking.

OBJECTIVE: This study aimed to evaluate the feasibility of an automated 2-way text messaging intervention nested in an ongoing preconception health trial, the Healthy Life Trajectories Initiative (HeLTI; HeLTI Bukhali) in Soweto, South Africa. Second, we aimed to evaluate the acceptability of a health promotion radio serial, which aired concurrently in the region.

METHODS: In this feasibility study, 120 participants enrolled in HeLTI Bukhali between November 2020 and February 2021 received the 6-month 2-way text messaging intervention. Quantitative and qualitative data on intervention acceptability, usability, interaction, perceived benefit, and fidelity were collected during 5 focus group discussions (FGDs) and from study data logs. During the FGDs, data were collected on the acceptability of the radio serial. Following the text messaging intervention, capillary hemoglobin levels were assessed, and a participant questionnaire provided information on adherence and attitudes toward supplements. The text messaging control group comprised the first 120 women recruited from November 2019 to February 2020, who received the Bukhali intervention but not the text messages. Statistical significance testing and a linear mixed model were used for indicative effect comparisons between the text message-receiving and control groups.

RESULTS: The text messaging intervention was found to be acceptable and to have perceived benefits, including being reminded to take supplements, gaining knowledge, and feeling supported by the study team. The use of the 2-way text messaging reply function was limited, with only a 10.8% (13/120) response rate by week 24. Barriers to replying included a lack of interest or phone credit and technical issues. Regarding the indicative effect, participants receiving the text messages had higher self-reported adherence at follow-up than the text messaging control group (42/63, 67% vs 33/85, 39% taking supplements every time; P=.02), and altitude-adjusted hemoglobin increased more between baseline and follow-up in the SMS text message-receiving group than in the text messaging control group (1.03, 95% CI 0.49-1.57; P<.001). The radio serial content was acceptable, although few participants reported exposure before the FGD.

CONCLUSIONS: Women reported that the text messaging intervention was useful and described the benefits of receiving the messages. Examination of hemoglobin status indicated a promising beneficial effect of text messaging support on adherence to micronutrient supplementation, requiring further exploration through randomized controlled studies. Health promotion through radio and text messages were both found to be acceptable, although more research into the radio serial reach among young women is needed.

TRIAL REGISTRATION: Pan African Clinical Trials Registry (PACTR) PACTR201903750173871; https://tinyurl.com/4x6n32ff.

PMID:35980731 | DOI:10.2196/37309