Tag: pubmed

J Pharm Technol. 2020 Oct;36(5):187-195. doi: 10.1177/8755122520942762. Epub 2020 Aug 26.

ABSTRACT

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are estimated to cost $1.5 billion annually in Canada. Previous studies have shown that barely half of all patients receive ideal care in hospitals. Deviations from guideline-defined optimal care lead to longer hospital stays, readmissions, and increased mortality. Objective: To determine the proportion of patients admitted to hospital for AECOPD who received treatment adherent to guidelines. Methods: A retrospective cohort study was conducted with ethics approval from the University of British Columbia Clinical Research Ethics Board. Patients hospitalized for ≥24 hours with an AECOPD at a tertiary care center and a community hospital were assessed. Guideline-adherent treatment was defined as appropriate use of supplemental oxygen, inhaled bronchodilators, systemic corticosteroids, antibiotics, venous thromboembolism prophylaxis, initiation/continuation of nicotine replacement therapy for current smokers, and vaccination optimization, reflecting international standards of care. Outcomes were assessed using descriptive statistics. Results: A random sample of 210 patients were selected of which 99 met inclusion criteria. Only 4% received therapy that met all recommendations. Differences in management were found between sites, specifically the appropriate use of bronchodilators, corticosteroids, antibiotics, and supplemental oxygen. Venous thromboembolism prophylaxis and smoking cessation rates were 97% and 94%, respectively, at the tertiary care center, compared with 73% and 100% at the community hospital. Additionally, less than half of all patients had their immunization history verified. Conclusion: Gaps in the inpatient management of AECOPD continue to exist. Initiatives must be targeted to optimize management and reduce the burden of the disease.

PMID:34752527 | PMC:PMC7453477 | DOI:10.1177/8755122520942762

J Pharm Technol. 2021 Feb;37(1):23-29. doi: 10.1177/8755122520952436. Epub 2020 Oct 13.

ABSTRACT

Background: Thioguanine (TG) is available only in the form of 40 mg tablets in the United States, and the patient population in which TG is used comprises mostly children. Recognizing its importance as a therapeutic agent and limited stability data for its compounded preparation, the United States Pharmacopoeia has listed TG in its priority list of compounded preparations monographs. Objective: The goal of the present study was to generate stability data and establish a beyond-use date for compounded TG suspension. Methods: Suspensions were compounded using TG tablets and ORA-Plus and ORA-Sweet as vehicles. A robust high-performance liquid chromatography method was developed and validated. TG and guanine (G) in suspensions were quantified immediately after compounding and at regular intervals for 90 days. Physical stability of suspensions was evaluated by observation of organoleptic properties. Results: Results from the study indicate that average TG levels in suspensions remained above 90% of the starting concentration and G formation was less than 2.5% for 90 days. There was no statistically significant difference in the amount of TG degraded over 90 days between suspensions stored at room temperature and in refrigerated conditions. There was also no statistically significant difference in G concentration of suspensions between day 0 and day 90. Conclusion: TG suspensions are stable for 90 days when stored at room temperature or refrigerated conditions and the beyond-use date can be set to 90 days.

PMID:34752544 | PMC:PMC7809332 | DOI:10.1177/8755122520952436

PLoS One. 2021 Nov 9;16(11):e0259723. doi: 10.1371/journal.pone.0259723. eCollection 2021.

ABSTRACT

BACKGROUND: Induction of labor (IOL) is an essential intervention to reduce adverse maternal and neonatal outcomes. It is also improved pregnancy outcomes, especially in resource-limited countries, where maternal and perinatal mortality is unacceptably high. However, there is a scarcity of evidence regarding the outcome of induction of labor and its predictors in low-income countries like Sub-Saharan Africa. Therefore, this study was aimed at assessing the outcome of induction of labor and associated factors among mothers who underwent labor induction in public Hospitals of Harari Regional State, Estern Ethiopia.

METHODS: A facility-based cross-sectional study was conducted from 1 to 30 March, 2019 in Harari Regional State, Eastern Ethiopia. A total of 717 mothers who underwent induction of labor in public Hospitals of Harari Regional State, Eastern Ethiopia from January 2017 to December 2018 were enrolled in the study. Data were collected using a pretested structured questionnaire. The collected data were entered into Epi-data version 3.1 and exported to SPSS version 24 (IBM SPSS Statistics, 2016) for further analysis. A multivariable logistic regression analysis was performed to estimate the effects of each predictor variable on the outcome of induction of labor after controlling for potential confounders. Statistical significance was declared at p-value <0.05.

RESULTS: Overall, the prevalence of success of induction of labor was 65% [95% CI (61.5, 68.5)]. Pre-eclampsia/eclampsia was found to be the most common indication for induction of labor (46.70%) followed by pre-labor rupture of fetal membrane (33.5%). In the final model of multivariable analysis, predictors such as: maternal age < 24 years old [AOR = 1.93, 95%CI(1.14, 3.26)], nulliparity[AOR = 0.34, 95%CI(0.19, 0.59)], unfavorable Bishop score [AOR = 0.06, 95%CI(0.03, 0.12)], intermediate Bishop score [AOR = 0.08, 95%CI(0.04, 0.14)], misoprostol only method [AOR = 2.29, 95%CI(1.01, 5.19)], nonreassuring fetal heart beat pattern [AOR = 0.14, 95%CI (0.07, 0.25)] and Birth weight 3500 grams and above[AOR = 0.32, 95% CI (0.17, 0.59)] were statistically associated with the successful outcome of induction of labor.

CONCLUSION: The prevalence of successful of induction of labor was relatively low in this study area because only two-thirds of the mothers who underwent induction of labor had a successful of induction. Therefore, this result calls for all stakeholders to give more emphasis on locally available induction protocols and guidelines. In addition, pre-induction conditions must be taken into consideration to avoid unwanted effect of failed induction of labour.

PMID:34752507 | DOI:10.1371/journal.pone.0259723

J Surg Educ. 2021 Nov 5:S1931-7204(21)00270-1. doi: 10.1016/j.jsurg.2021.09.023. Online ahead of print.

ABSTRACT

OBJECTIVE: Emotional intelligence (EI) is associated with job success in multiple fields, in part, because EI may mitigate stress and burnout. Research suggests these relationships may include teaching. Our purpose is to further explore the relationships between EI, burnout, and teaching for faculty surgeons.

DESIGN: With IRB approval, surgical faculty were offered the opportunity to complete personal demographics, the Maslach Burnout Inventory, the SETQ-SMART assessment of teaching ability, and the SEF:MED self-assessment of emotional intelligence. Surgical residents rated faculty teaching ability using the SETQ-SMART SETTING: A medium-sized academic medical center in the Southeast approved to graduate 6 residents per year.

PARTICIPANTS: ACGME surgical faculty and general surgical residents PGY1 to PGY5 including preliminary residents, were given the opportunity to participate.

RESULTS: Faculty self-assessed teaching scores were significantly different from resident scores for nine (60%) faculty; three (33%) overrated their and 6 (67%) under rated their overall teaching ability, relative to resident ratings. The 3 SEF:MED scales correlated low-moderate to strongly with the SETQ-OTS: IS (r = 0.41, p = 0.13), EM (r = 0.67, p < 0.01), and EA (r = 0.43, p = 0.11). Overall, 8(53%) faculty scored moderate to high on at least 1 of the 3 MBI subscales. Overall self-rated faculty teaching scores correlated negatively with higher EE and DP and positively with PA (r = -0.08, -0.21, and 0.52, p = 0.047; respectively). EI negatively correlated with MBI-EE and DP and positively with PA (r = -0.31, -0.18, 0.45, respectively), though due to the small sample none reach statistical significance with alpha set to 0.05.

CONCLUSIONS: In this pilot study, EI is positively correlated to surgical faculty members’ teaching ability. Burnout was less strongly correlated with resident-assessed faculty teaching scores, but with similar trends. Finally, EI was correlated with MBI EE, DP, and PA as expected given the literature in other fields. Expanded study is warranted.

PMID:34750078 | DOI:10.1016/j.jsurg.2021.09.023

Brachytherapy. 2021 Nov 5:S1538-4721(21)00487-6. doi: 10.1016/j.brachy.2021.09.007. Online ahead of print.

ABSTRACT

PURPOSE: This study investigated the correlation between the prescription dose and dose to the Manchester and International Commission on Radiation Units and Measurements-report 38 (ICRU-38) lymphatic trapezoid points during high-dose-rate (HDR) brachytherapy of locally advanced cervical cancer with (Cobalt-60) 60Co .

METHODS AND MATERIALS: A retrospective study was designed for; patients with locally advanced cervical cancer, treated by external beam radiotherapy and concurrent weekly Cisplatin-based chemotherapy, had no extended parametrial invasion and was treated by tandem-ovoid set, from 2017 to 2020. Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology (GEC-ESTRO) based target’s volume, ICRU-89 revised version of Manchester points A and B, and ICRU-38 lymph node surrogate points were determined, and their dose was recorded. Paired sample t-test, linear regression analysis, and Pearson correlation analyses were done considering a statistical significance level of 0.05 and using IBM SPSS statistics (Version 23, IBM Crop.).

RESULTS: Seventy-four brachytherapy cases were included. A positive and strong correlation was observed between D₉₀ of clinical target volume (CTV_HR) and points A and B dose for CTV_HR〈 15 cc and 〉 35 cc. Strong and significant (p < 0.05) correlations were achieved between pelvic wall points dose and D₉₀ and D₁₀₀ of the obturator and between D₅₀ and hot points of internal iliac lymph nodes. A strong correlation was obtained between D₅₀ and D₉₀ of external iliac lymph nodes and their ICRU points.

CONCLUSIONS: Strong correlations were obtained between dose to the pelvic lymphatic chains and their historical ICRU-38 surrogate points during HDR brachytherapy of locally advanced cervical cancer patients with 60Co tandem-ovoid applicator sets. The correlation strength between point A and prescription dose highly depends on the CTV_HR volume.

PMID:34750084 | DOI:10.1016/j.brachy.2021.09.007

Urol Oncol. 2021 Nov 5:S1078-1439(21)00446-4. doi: 10.1016/j.urolonc.2021.09.019. Online ahead of print.

ABSTRACT

PURPOSE: Collecting duct carcinoma is a rare pathologic entity with a paucity of clinical data in the literature. We aim to evaluate our institutional experience with the management of this disease.

MATERIALS AND METHODS: All renal tumors in the Mayo Clinic Nephrectomy Registry were re-reviewed retrospectively by an expert urologic pathologist. Cases of collecting duct carcinoma were identified. Descriptive statistics were used to characterize these cases. Overall survival and metastases-free survival were estimated using Kaplan-Meier methodology.

RESULTS: Between 1970 and 2018, a total of 21 cases were identified with an incidence of 0.2%. Cases were seen predominantly in men (N = 17, 81%) with a median age at diagnosis of 57 years old. At the time of nephrectomy, high grade disease (grade 3 or 4) was noted in the majority of patients (90%). The median times to local recurrence and distant metastases were 5.6 and 5.1 months, respectively. Median overall survival occurred at 1.5 years. Median distant metastases-free survival among M0 patients occurred at 0.5 years. Four patients with localized disease and small tumor size who underwent nephrectomy lived longer than 10 years. No systemic therapies achieved a durable response in the metastatic setting.

CONCLUSION: The Mayo Clinic nephrectomy registry contains 21 patients with collecting duct carcinoma over nearly 50 years. Early local recurrence and distant metastases were seen after nephrectomy. However, M0 patients with a small tumor may have long-term benefits from nephrectomy. Neither chemotherapy nor targeted therapy resulted in a durable response in the metastatic setting.

PMID:34750052 | DOI:10.1016/j.urolonc.2021.09.019

J Cardiol. 2021 Nov 5:S0914-5087(21)00282-3. doi: 10.1016/j.jjcc.2021.10.011. Online ahead of print.

ABSTRACT

BACKGROUND: The prognostic significance of combining intra-aortic balloon pumping (IABP) with extracorporeal membrane oxygenation (ECMO) for acute myocardial infarction (AMI) patients is still unclear. We investigated whether combining IABP with veno-arterial (VA)-ECMO is associated with a lower risk of short-term mortality.

METHODS: Among 12,093 AMI cases enrolled in the Osaka Acute Coronary Insufficiency Study (OACIS), we identified 519 who were administered VA-ECMO during hospitalization. Among these, 459 received IABP support (IABP group) and 60 cases did not (no-IABP group). The primary endpoint was 30-day all-cause death; the secondary endpoint was major bleeding. Logistic regression analysis using original data was conducted. We also established weighted logistic regression models with inverse probability of treatment weighting (IPTW).

RESULTS: Logistic regression analysis revealed that IABP use was significantly associated with a reduced risk of 30-day death in the original data [odds ratio (OR) 0.504, 95% confidence interval (CI) 0.282-0.901, p = 0.021]. After IPTW-adjustment for clinically relevant covariates with the use of IABP, patients receiving VA-ECMO with IABP had a lower risk of 30-day death (OR 0.816, 95% CI 0.746-0.892, p < 0.001) compared to those without IABP. The incidence of major bleeding was comparable between the groups (IABP 29.0% vs. non-IABP 21.7%, p=0.302). However, the risk of major bleeding was higher in the IABP group after IPTW-adjustment (OR 1.092, 95% CI 1.008-1.184, p=0.032).

CONCLUSIONS: IABP support for AMI patients with VA-ECMO was significantly associated with reduced risk of short-term mortality, suggesting that the addition of IABP support might contribute to improved survival in AMI patients requiring VA-ECMO.

PMID:34750027 | DOI:10.1016/j.jjcc.2021.10.011

Intensive Crit Care Nurs. 2021 Sep 7:103139. doi: 10.1016/j.iccn.2021.103139. Online ahead of print.

ABSTRACT

OBJECTIVES: To provide insights into visiting policies and family-centred care practices with a focus on children as visitors in Intensive Care Units in German-speaking countries.

METHODS/DESIGN: Online-survey with a mixed methods approach. Leading clinicians (n = 1943) from German-speaking countries were invited to participate. Outcomes included the percentage of intensive care units with open visiting policies, age restrictions, family-centred care activities and barriers.

SETTING: Paediatric, mixed and adult units RESULTS: In total, 19.8% (n = 385) of the clinicians responded. Open visiting times were reported by 36.3% (n = 117), with significant differences between paediatric (79.2%), adult (21.3%) and mixed-age (41.2%) units (p < 0.01). Two-thirds of clinicians stated that their units had no age restrictions for children as visitors (n = 221, 68.4%). The family-centred care activities most frequently implemented were open visiting times and dissemination of information. Significantly more German units have open visiting policies and more Swiss units allow children as visitors, compared to the other countries (both p < 0.001). Barriers to family-centred care were concerns about children being traumatized, infection and workload.

CONCLUSION: The majority reported that family-centred care policies had been implemented in their units, including open visiting policies, allowing children as visitors without age restriction and other family-centred care activities.

PMID:34750041 | DOI:10.1016/j.iccn.2021.103139

Clin Ther. 2021 Nov 5:S0149-2918(21)00388-X. doi: 10.1016/j.clinthera.2021.09.014. Online ahead of print.

ABSTRACT

Real-world data derived from observational studies, particularly from administrative health care and insurance claims databases, are increasingly being used to evaluate treatment effectiveness. To control for potential biases, a number of analytical techniques have been developed. However, the procedures used can be far from intuitive, and this along with other methodological issues can make it challenging to assess whether reported results are real or artefactual. This commentary summarizes some of the issues associated with evaluating treatment effectiveness in the real-world setting, at the same time highlighting the important role observational studies can play.

PMID:34750019 | DOI:10.1016/j.clinthera.2021.09.014

Wei Sheng Yan Jiu. 2021 Sep;50(5):821-826. doi: 10.19813/j.cnki.weishengyanjiu.2021.05.019.

ABSTRACT

OBJECTIVE: To study the effects of fine particulate matter(PM_(2.5))exposure to cognitive function and intestinal flora abundance and diversity in adult male mice.

METHODS: The SPF grade male C57 BL/6 J mice with 8 weeks old were randomly divided into control group(NS group), PM_(2.5) exposure group(PM_(2.5) group), probiotic group(VSL#3 group) and PM_(2.5) + VSL#3 group(PMV group), with 8 mice in each group. The PM_(2.5) group and PMV group mice were exposed to PM_(2.5) using animal exposure system equipped with real-time PM_(2.5) concentration, and concentrated 6 times the outdoor PM_(2.5) concentration, 8 h every day, 5 d every week for 4 weeks. The VSL#3 group and PMV group mice were given VSL#3, 0.5 mL, 2×10~9 CFU/mL. After four weeks of exposure, feces from mice were collected for 16 s rRNA high-throughput sequencing, and the cognitive function was evaluated using Morris water maze and object recognition experiments.

RESULTS: The escape latency of PM_(2.5) group in four-day training [(54.99±6.77) s, (41.21±9.98) s, (36.27±13.11) s, (30.01±14.80) s] were higher than that of NS group [(32.19±4.59) s, (20.50±6.77) s, (19.93±7.30) s, (16.94±9.91) s], and the difference were statistically significant(P&lt;0.05). The escape latency of PMV group on the first and second day of training [(39.02±6.23) s, (28.83±9.53) s] were lower than that of PM_(2.5) group(P&lt;0.05). The target quadrant residence time of mice in PM_(2.5) group [(18.30± 8.88) s] was lower than that in NS group and PMV group [(30.53±9.10) s, (30.00±10.61) s]. Compared with NS group(6.09±0.40), the shannon index of PM_(2.5) group and PMV group(5.05±0.65 and 5.46±0.52) were significantly reduced(P&lt;0.05). The target quadrant time was positively correlated with the relative abundance of Actinomyces(r=0.576, P&lt;0.05), and the recognition index was positively correlated with the relative abundance of Firmicutes(r=0.612, P&lt;0.05).

CONCLUSION: PM_(2.5) could lead to cognitive dysfunction in mice, which is related to diversity and abundance of the intestinal flora. Probiotic can improve cognitive function.

PMID:34749878 | DOI:10.19813/j.cnki.weishengyanjiu.2021.05.019