Tag: pubmed

Hosp Pediatr. 2022 Jul 6:e2021006366. doi: 10.1542/hpeds.2021-006366. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Schwartz Rounds (SR) is an interdisciplinary program that focuses on compassionate care by allowing the formation of an interprofessional community around the human and emotional testimonies of caregivers. The purpose of this study was to examine the impact of implementing departmental SR on pediatric care providers at a tertiary care children’s hospital in New York.

METHODS: We applied the logic outcomes model for program evaluation to examine the impact of SR on pediatric providers. The standard evaluation form provided by the Schwartz Center was used to collect data after every SR. Descriptive statistics and qualitative data content analysis methods were used to analyze the evaluation data from the SR.

RESULTS: A total of 820 standard evaluation forms were collected from 17 of the 23 SR sessions offered (response rate: 74.8%). Most participants felt that, during the SR sessions, challenging social and emotional aspects of patient care were discussed and that they gained better perspectives of their coworkers and their patients/families. They reported less isolation and more openness to express their feelings about patient care to their coworkers. The analysis of 299 written comments identified 5 themes: understanding other people’s perspectives, the importance of communication, empathy and compassion, awareness of personal biases, and maintaining boundaries.

CONCLUSIONS: Schwartz Rounds can provide an effective venue for pediatric care providers to gain insights into coworker and patient/family perspectives and process emotional experiences while providing patient care in a variety of circumstances.

PMID:35791770 | DOI:10.1542/hpeds.2021-006366

Plast Reconstr Surg. 2022 Jul 6. doi: 10.1097/PRS.0000000000009441. Online ahead of print.

ABSTRACT

BACKGROUND: Targeted muscle reinnervation (TMR) has emerged as a technique to reduce neuroma and phantom limb pain after below knee amputation (BKA); however, the incidence of post-operative complications remains unknown. This multi-institutional study assessed the risk of post-operative complications among patients who underwent TMR at the time of BKA (BKA+TMR).

STUDY DESIGN: Patients who underwent BKA+TMR were propensity score-matched 1:3 to patients who underwent BKA only. Study outcomes included the incidence of major or minor complications within 60 days. Regression models were utilized to estimate the relative risk (RR) of major and minor complications.

RESULTS: Overall, 96 patients were matched including 31 BKA+TMR and 65 BKA only. In the matched sample, a higher incidence of major complications (29% vs. 24.6%), readmission (25.8% vs. 18.5%) and reoperation (19.4% vs. 10.8%) was seen after BKA+TMR compared to BKA only. Furthermore, patients who underwent BKA+TMR displayed a higher incidence of minor complications (25.8% versus 20.0%), blood transfusion (22.6% vs. 18.5%), wound healing complications (45.2% vs. 33.8%), and longer operative time (mean [standard deviation] 188.5 [63.6] vs. 88 [28.2] minutes). However, there was no statistically significant difference in the risk of major (RR:1.20, 90% confidence interval (CI):0.68, 2.11) or minor (RR:1.21, 90% CI:0.61, 2.41) complications between the two cohorts.

CONCLUSION: Despite an increased incidence of post-operative complications, undergoing BKA+TMR does not confer a statistically significant increased risk of major or minor complications. Future studies are needed to delineate patient selection criteria when assessing the suitability of TMR at the time of major limb amputation.

PMID:35791757 | DOI:10.1097/PRS.0000000000009441

Paediatr Anaesth. 2022 Jul 6. doi: 10.1111/pan.14519. Online ahead of print.

ABSTRACT

BACKGROUND: To reduce risk for intermittent hypoxia a high fraction of inspired oxygen is routinely used during anesthesia induction. This differs from the cautious dosing of oxygen during neonatal resuscitation and intensive care and may result in significant hyperoxia.

AIM: In a randomized controlled trial we evaluated oxygenation during general anesthesia with a low (23%) vs a high (80% during induction and recovery, and 40% during maintenance) fraction of inspired oxygen, in newborn infants undergoing surgery.

METHOD: Thirty-five newborn infants with postconceptional age of 35-44 weeks were included (17 infants in low and 18 in high oxygen group). Oxygenation was monitored by transcutaneous partial pressure of oxygen, pulse oximetry, and cerebral oxygenation. Pre-defined SpO2 safety targets dictated when to increase inspired oxygen.

RESULTS: At start of anesthesia oxygenation was similar in both groups. Throughout anesthesia the high oxygen group displayed significant hyperoxia with higher (difference -20.3kPa, 95% confidence interval (CI) -28.4 – -12.2, p < .001) transcutaneous partial pressure of oxygen values than the low oxygen group. While SpO2 in the low oxygen group was lower (difference -5.8%, 95% CI -9.3 – -2.4, p < .001) during anesthesia, none of the infants spent enough time below SpO₂ safety targets to mandate supplemental oxygen, and cerebral oxygenation was within the normal range and not statistically different between the groups. Analysis of the oxidative stress biomarker urinary F₂ -Isoprostane revealed no differences between the low and high oxygen group.

CONCLUSION: We conclude that in healthy newborn infants use of low oxygen during general anesthesia was feasible, while the prevailing practice of using high levels of inspired oxygen resulted in significant hyperoxia. The trade-off between careful dosing of oxygen and risks of hypo- and hyperoxia in neonatal anesthesia should be further examined.

PMID:35791748 | DOI:10.1111/pan.14519

Biostatistics. 2022 Jul 6:kxac020. doi: 10.1093/biostatistics/kxac020. Online ahead of print.

ABSTRACT

When evaluating the effectiveness of a treatment, policy, or intervention, the desired measure of efficacy may be expensive to collect, not routinely available, or may take a long time to occur. In these cases, it is sometimes possible to identify a surrogate outcome that can more easily, quickly, or cheaply capture the effect of interest. Theory and methods for evaluating the strength of surrogate markers have been well studied in the context of a single surrogate marker measured in the course of a randomized clinical study. However, methods are lacking for quantifying the utility of surrogate markers when the dimension of the surrogate grows. We propose a robust and efficient method for evaluating a set of surrogate markers that may be high-dimensional. Our method does not require treatment to be randomized and may be used in observational studies. Our approach draws on a connection between quantifying the utility of a surrogate marker and the most fundamental tools of causal inference-namely, methods for robust estimation of the average treatment effect. This connection facilitates the use of modern methods for estimating treatment effects, using machine learning to estimate nuisance functions and relaxing the dependence on model specification. We demonstrate that our proposed approach performs well, demonstrate connections between our approach and certain mediation effects, and illustrate it by evaluating whether gene expression can be used as a surrogate for immune activation in an Ebola study.

PMID:35791753 | DOI:10.1093/biostatistics/kxac020

Kidney Res Clin Pract. 2022 Jun 21. doi: 10.23876/j.krcp.22.023. Online ahead of print.

ABSTRACT

BACKGROUND: Hemodialysis (HD) patients are more vulnerable to viral epidemics, experiencing higher mortality rates compared to individuals without chronic kidney disease (CKD). This retrospective cohort study sought to demonstrate clinical outcomes and associated factors among coronavirus disease 2019 (COVID-19) confirmed Korean HD patients.

METHODS: From February 2020 to November 2021, the COVID-19 Task Force Team collected clinical data for HD patients with confirmed COVID-19 via a self-report survey of nephrologists. The composite outcome included in-hospital mortality, admission to the intensive care unit (ICU), and use of mechanical ventilation. Risk factors associated with clinical outcomes were analyzed among HD patients and compared to those of individuals without CKD using the COVID-19 database from the Korea Disease Control and Prevention Agency.

RESULTS: A total of 380 HD patients from 206 facilities were diagnosed with COVID-19. Fever (49.5%) and cough (25.7%) were the two most common initial symptoms. The overall in-hospital fatality rate was 22.4% and even higher among ICU admission cases (64.7%). Non-survivors were older, more frequently developed shortness of breath, and were more likely to come from a nursing hospital. Compared to the age- and sex-matched non-CKD population, HD patients showed greater risk of in-hospital mortality (hazard ratio, 2.07; 95% confidence interval, 1.56-2.75; p < 0.001) and composite outcome (hazard ratio, 3.50; 95% confidence interval, 2.56-4.77; p < 0.001).

CONCLUSION: HD patients have a greater risk of in-hospital mortality and morbidity from COVID-19. Special attention should be paid to COVID-19 HD patients when they are older or present with symptoms.

PMID:35791744 | DOI:10.23876/j.krcp.22.023

Anatol J Cardiol. 2022 Jul;26(7):559-566. doi: 10.5152/AnatolJCardiol.2022.1136.

ABSTRACT

BACKGROUND: It is unknown whether the novel POT-side-POT technique is more useful than the commonly preferred kissing balloon inflation in patients with non-complex coro- nary bifurcation lesions treated with a single-stent strategy. The aim of this study was to compare the efficacy of POT-side-POT and kissing balloon inflation techniques in one- stent strategy for non-complex coronary bifurcation lesions.

METHODS: In this study, 283 patients were retrospectively analyzed (POT-side-POT group, n = 149; KBI group, n = 134). Primary endpoints of the study were defined as follows: in- hospital and 30-day mortality, contrast-induced acute kidney injury, stent thrombosis, side branch dissection, and need for side-branch stenting. Characteristics of patients at baseline were balanced by using propensity score inverse probability weighting.

RESULTS: Procedure time (minute, 30.6 ± 8.5 vs. 34.3 ± 11.6; P = .003) and contrast volume (milliliter, 153.7 ± 42.4 vs. 171.1 ± 58.2; P = .004) were significantly lower in POT-side-POT group. Besides, side branch residual stenosis and number of patients with >50% side branch residual stenosis remained significantly higher in POT-side-POT group both in general and true bifurcation subgroup analysis (20.3 ± 19.8% vs. 16.5 ± 16.4%, P=.022; 11.9% vs. 5.7%, P = .013 and 24.1 ± 23.2% vs. 18.8 ± 18.7%, P = .033; 17.6% vs. 6.6%, P = .005; respectively). Combined clinical adverse outcomes were similar between groups. Side branch dissection (10.2% vs. 20.1%, P = .001) and need for side branch stenting (12.6% vs. 19%, P=.040) reached statistically significance in kissing balloon inflation group after adjustment.

CONCLUSION: POT-side-POT may be a simple and safe technique with a shorter procedure time and lower incidence of adverse clinical events in non-complex coronary bifurcationlesions treated with single-stent strategy.

PMID:35791712 | DOI:10.5152/AnatolJCardiol.2022.1136

Cardiol Young. 2022 Jul 6:1-7. doi: 10.1017/S1047951122002189. Online ahead of print.

ABSTRACT

INTRODUCTION: The present study aimed to investigate the outcomes of psychiatric symptoms and family functions on treatment adherence in children, in addition to sociodemographic characteristics and clinical factors related to the disease.

MATERIAL AND METHOD: The research sample consisted of 43 children who were followed up with rheumatic heart disease diagnosis during the study. Clinical features were obtained from the patient files. The family assessment device evaluating family functioning and the strengths and difficulties questionnaire scale to screen emotional and behavioural problems in children were used.

RESULTS: Considering the regularity of treatment in our patients, there were 31 (72%) patients adherent to secondary prophylaxis regularly, 7 (6.9%) patients were partially adherent, and 5 (11.6%) patients non-adherent. Patients were divided into treatment adherent (Group 1) and non-adherent (Group 2). There was no statistically significant impact on treatment adherence whether the patients receive enough information, lifestyle, fear of developing adverse effects, fear of addiction, lack of health insurance, difficulties in reaching the drug or hospital. However, the fear of syringes on treatment adherence had an effect statistically significantly (p = 0.047). Forgetting to get a prescription and/or take the drug when the time comes was statistically higher in the non-adherent group (p = 0.009). There was no statistically significant effect of psychosocial factors on treatment adherence between groups.

DISCUSSION: Providing an effective active recall system, involving primary care workers, providing training on the disease and its management, and a comprehensive pain management programme can improve the process, especially for cases where secondary prophylaxis is missed.

PMID:35791698 | DOI:10.1017/S1047951122002189

Clin Shoulder Elb. 2022 Jun 14. doi: 10.5397/cise.2021.00598. Online ahead of print.

ABSTRACT

BACKGROUND: This study was designed to evaluate and compare the diagnostic value of magnetic resonance imaging (MRI) and indirect magnetic resonance arthrography (I-MRA) imaging with those of arthroscopy and each other.

METHODS: This descriptive-analytical study was conducted in 2020. All patients who tested positive for labrum lesions during that year were included in the study. The patients underwent conservative treatment for 6 weeks. In the event of no response to conservative treatment, MRI and I-MRA imaging were conducted, and the patients underwent arthroscopy to determine their ultimate diagnosis and treatment plan. Imaging results were assessed at a 1-week interval by an experienced musculoskeletal radiologist. Image interpretation results and arthroscopy were recorded in the data collection form.

RESULTS: Overall, 35 patients comprised the study. Based on the kappa coefficient, the results indicate that the results of both imaging methods are in agreement with the arthroscopic findings, but the I-MRA consensus rate is higher than that of MRI (0.612±0.157 and 0.749±0.101 vs. 0.449±0.160 and 0.603±0.113). The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of MRI in detecting labrum tears were 77.77%, 75.00%, 91.30%, 50.00%, and 77.14%, respectively, and those of I-MRA were 88.88%, 75.00%, 92.30%, 66.66%, and 85.71%.

CONCLUSIONS: Here, I-MRA showed higher diagnostic value than MRI for labral tears. Therefore, it is recommended that I-MRA be used instead of MRI if there is an indication for potential labrum lesions.

PMID:35791684 | DOI:10.5397/cise.2021.00598

Int J Neurosci. 2022 Jul 6:1-9. doi: 10.1080/00207454.2022.2098737. Online ahead of print.

ABSTRACT

PURPOSE OF THE STUDY: Previous studies have established that telomere length is associated with Multiple sclerosis(MS). However, confounding factors and reverse causality bias can impair observational research. Here, we conducted a two-sample MR study to see if telomere length is causally linked to MS using publically available GWAS summary statistics.

MATERIALS AND METHODS: We screened 13 independent single-nucleotide polymorphisms (SNPs) related to leukocyte telomere length in a recent genome-wide association meta-analysis, which was available for 78,592 samples of European ancestry. The summary statistics for MS were from the latest meta-analyses conducted by the International Multiple Sclerosis Genetics Consortium (IMSGC), which included 115,803 European participants (47,429 MS, 68,374 controls).

RESULTS: We found that leukocyte telomere length and MS are correlated (IVW estimate of odds ratio (OR): 2.13 per 1-SD increase in genetically determined telomere length, 95% confidence interval (CI): 1.55-2.92, P =3.18 × 10-6).

CONCLUSION: Our MR study supported that leukocyte telomere length and MS have a positive causal relationship. Further researches are warranted to elucidate the physiological mechanism.

PMID:35791675 | DOI:10.1080/00207454.2022.2098737

Vox Sang. 2022 Jul 6. doi: 10.1111/vox.13330. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: This sub-study of the FIBRES trial sought to examine the patterns of ABO-compatible cryoprecipitate administration and to identify adverse consequences of ABO-incompatible cryoprecipitate.

MATERIALS AND METHODS: This was a post hoc analysis of data collected from the FIBRES randomized clinical trial comparing fibrinogen concentrate with cryoprecipitate in the treatment of bleeding related to hypofibrinogenemia after cardiac surgery. The primary outcome was the percentage of administered cryoprecipitate that was ABO-compatible. Secondary outcomes were adverse events at 28 days. A follow-up survey was distributed to the FIBRES participating sites to examine the rationale behind the identified cryoprecipitate ABO-matching practice patterns.

RESULTS: A total of 363 patients were included: 53 (15%) received ABO-incompatible cryoprecipitate and 310 (85%) received ABO-compatible cryoprecipitate. There was an increased incidence of post-operative anaemia in the ABO-incompatible group (15; 28.3%) in comparison to the ABO-compatible (44; 14.2%) group (p = 0.01) at 28 days, which was unrelated to haemolysis, without a significant difference in transfusion requirement. In the multivariable logistic regression models accounting for clustering by site, there was no observed statistically significant association between the administration of ABO-incompatible cryoprecipitate and any other adverse outcomes. Nine out of 11 sites did not have a policy requiring ABO-matched cryoprecipitate.

CONCLUSION: This sub-study demonstrated that most cryoprecipitate administered in practice is ABO-compatible, despite the absence of guidelines or blood bank policies to support this practice. A signal towards increased risk of post-operative anaemia may be explained by higher rates of urgent surgery (vs. elective) in the ABO-incompatible group. Future studies should prospectively examine the impact of ABO-compatible versus incompatible cryoprecipitate to conclusively establish if there is a meaningful clinical impact associated with the administration of ABO-incompatible cryoprecipitate.

PMID:35791670 | DOI:10.1111/vox.13330