Tag: pubmed

Phys Ther. 2022 Jun 29:pzac051. doi: 10.1093/ptj/pzac051. Online ahead of print.

ABSTRACT

OBJECTIVE: Guidelines recommend supervised exercise therapy and lifestyle counseling by a physical therapist as initial treatment of patients with intermittent claudication. However, guidelines provide only a crude estimate of the outcomes that therapists and patients might expect from treatment. The purpose of this study was to explore the impact of personalized outcomes forecasts (POFs) on the decision-making process of physical therapists and to learn lessons on facilitating the use of forecasts in daily practice.

METHODS: A vignette-based, think-aloud interview study design was used. The participants were physical therapists trained in treating patients with intermittent claudication. Vignettes described fictitious patients diagnosed with intermittent claudication and included POFs. A directed approach was used to code, organize, and describe the data. Transcripts were analyzed using a thematic approach.

RESULTS: Sixteen therapists participated in the study. Three themes were identified: (1) setting and contextualizing treatment expectations; (2) setting (shared) goals and (de)motivating the patient, and (3) establishing and monitoring the treatment plan. Therapists mentioned that POFs could be useful for setting expectations and realistic treatment goals, contextualizing expected treatment response, stimulating patients to achieve their goals, and deciding on treatment frequency and treatment timing. Therapists thought POFs would be of less use for changing treatment goals during follow-up visits or for establishing intensity or type of training.

CONCLUSION: To overcome challenges that may arise when adopting POFs in daily practice, adequate training of physical therapists should be conducted. Potential areas to address with training include statistical and data literacy as well as guidance on integrating POFs with existing treatment protocols.

IMPACT: The use of POFs by physical therapists might contribute to a more person-centered care approach. The insights provided by this study on the first use of POFs by physical therapists can serve as an example and lesson on how to optimally implement such supporting tools into daily practice.

PMID:35778937 | DOI:10.1093/ptj/pzac051

Acta Paediatr. 2022 Jul 2. doi: 10.1111/apa.16472. Online ahead of print.

ABSTRACT

AIM: The aim of this review was to compile existing evidence on the role of platelets in the development of severe retinopathy of prematurity (ROP), highlight the strengths and weaknesses of the available studies and critically discuss the reported data.

METHODS: A comprehensive literature search was conducted on PubMed from January 2000 to January 2022, and the reference lists of the included studies were screened manually.

RESULTS: There were 19 primary studies that fulfilled the eligibility criteria. Experimental research indicated lower platelet count in mice oxygen-induced retinopathy model compared with normoxia controls, while platelet transfusions suppressed neovascularisation. The latter finding was not consistently confirmed in clinical research, where a low platelet count, an increased number of thrombopenic episodes and of platelet transfusions have all been implicated in the development of ROP requiring treatment, either type I or aggressive posterior or both. However, existing studies exhibit significant clinical heterogeneity and present methodological limitations that imperil their reliability and validity.

CONCLUSION: Platelet deficiency has been associated with severe ROP. However, critical thresholds of platelet parameters are still unrecognised. Future research is required to determine whether platelet parameters can be predictive biomarkers for ROP requiring treatment and at what thresholds.

PMID:35778901 | DOI:10.1111/apa.16472

Eur J Clin Invest. 2022 Jul 1:e13830. doi: 10.1111/eci.13830. Online ahead of print.

ABSTRACT

BACKGROUND: The CHA₂ DS₂ -VASc score, widely used to estimate cardioembolic risk in patients with atrial fibrillation (AF), appears to be useful also in predicting vascular adverse events and death in different sets of patients without AF. The R₂ CHA₂ DS₂ -VASc score, which includes renal impairment, allows a better prediction of death and thromboembolism in patients without AF. The aims of our study were to assess, in a large sample of patients at high cardiovascular (CV) risk, i) the correlation between CHA₂ DS₂ -VASc and R₂ CHA₂ DS₂ -VASc with all-cause mortality, and ii) to compare the performances of CHA₂ DS₂ -VASc and R₂ CHA₂ DS₂ -VASc in predicting all-cause mortality.

METHODS: In this single-center prospective observational study, conducted at the Research Hospital “Casa Sollievo della Sofferenza” between June 2016 and December 2018, 1017 CV patients at high risk of undergoing coronary angiography were enrolled.

RESULTS: CHA₂DS₂-VASc and R₂ CHA₂ DS₂ -VASc scores significantly associated with all-cause mortality. For each one-point increase in CHA₂ DS₂ -VASc or R₂ CHA₂ DS₂ -VASc scores, mortality increased by almost 1.5-fold. The R₂ CHA₂ DS₂ -VASc score (C-statistic=0.71; 95%CI=0.65-76) outperformed the CHA₂ DS₂ -VASc score (C-statistic=0.66; 95%CI=0.61-0.71) in predicting 4-year mortality (delta C-statistic =0.05; 95%CI=0.02-0.07). The better predictive ability of the R-CHA₂ DS₂ -VASc score was also demonstrated by an IDI=0.027 (95CI=0.021-0.034, p<0.00001) and a relative IDI=62.8% (95%CI=47.9%-81.3%, p<0.00001). The R₂ CHA₂ DS₂ -VASc score correctly reclassified the patients with a NRI=0.715 (95%=0.544-0.940, p<0.00001).

CONCLUSIONS: The CHA₂DS₂-VASc and R₂ CHA₂ DS₂ -VASc scores are useful predictors of all-cause mortality in subjects at high CV risk, with the R₂ CHA₂ DS₂ -VASc score being the best performer.

PMID:35778894 | DOI:10.1111/eci.13830

Health Promot Pract. 2022 Jul 1:15248399221102919. doi: 10.1177/15248399221102919. Online ahead of print.

ABSTRACT

Gardening is associated with a wide array of health benefits. We describe the dissemination of a low-cost social media-based campaign (Grow This!), an intervention intended to reach novice gardeners and which combined elements of old (seeds) and new (Facebook) technology. Grow This! was implemented before (2018, 2019) and during (2020) the COVID pandemic, providing an interesting framework for understanding participants’ motivations for gardening. Pre- and post-surveys assessed a variety of topics, including participants’ motivations for participating in Grow This!, how they planned to participate, previous gardening experience, the main benefits attributed to participation, and intentions to garden in the future. Descriptive statistics and qualitative analysis were used to analyze the survey data. More than 25,000 people participated in Grow This! over the 3 years, with the majority (77%) participating as a family. Participation in the project spiked during COVID. Primary motivations for participating in Grow This! pre-COVID were education, enjoyment, family engagement, and self-sufficiency; during COVID, motivations remained the same, but shifted in rank. Just over a third of participants were novice gardeners. Participants attributed numerous benefits to their participation, including stress reduction/relaxation, more outdoor time, reduced grocery bills, and eating more fruits and vegetables than normal. A total of 83% of respondents reported being highly likely to have a garden in the future. Home gardening as an intervention is ripe for dissemination, particularly in the aftermath of COVID. Public health professionals can benefit from this understanding of people’s motivations to garden and the perceived benefits associated with gardening.

PMID:35778887 | DOI:10.1177/15248399221102919

Foot Ankle Int. 2022 Jul 1:10711007221108098. doi: 10.1177/10711007221108098. Online ahead of print.

ABSTRACT

BACKGROUND: There has been concern about lateral prominence pain at the osteotomy site following medial displacement calcaneal osteotomy (MDCO). However, no study has investigated this complication. This study aimed to investigate the incidence of lateral prominence pain following MDCO and examine the efficacy of crushplasty as a surgical technique to minimize this complication.

METHODS: This was a retrospective cohort study in which 137 patients (148 feet) who underwent MDCO were divided into 2 groups by whether they had concurrent crushplasty at the time of MDCO (crushplasty [n = 81] vs noncrushplasty group [n = 67]). Crushplasty was performed by flattening the bony step-off using a rongeur and bone impactor. Lateral prominence pain was defined as pain or irritating symptoms over the osteotomy site that persisted over 12 months after MDCO. The overall incidence of lateral prominence pain after MDCO and within each group was investigated. Multiple logistic regression analysis was used to determine the influence of possible risk factors on the development of postoperative lateral prominence pain.

RESULTS: The overall incidence of lateral prominence pain was 9.5% (14 of 148): 3.4% (3 of 87) in the crushplasty group, and 18% (11 of 61) in the noncrushplasty group, and χ² analysis showed a statistically significant relationship between crushplasty and lateral prominence pain (P < .05). A relationship between the amount of medial displacement and the development of lateral prominence pain was observed in the noncrushplasty group (OR = 5.31, 95% CI 2.35-16.4, P < .05), but this was not observed in the crushplasty group (P = .641). The amount of medial displacement was an independent risk factor for the development of lateral prominence pain (OR = 2.72, 95% CI 1.54-4.79, P < .05), and concurrent crushplasty had a negative relationship with lateral prominence pain development (OR = 0.12, 95% CI 0.03-0.57, P < .05).

CONCLUSION: This study revealed that lateral prominence pain is a significant complication of MDCO, especially in the setting of a larger displacement. The crushplasty following MDCO may minimize this complication, particularly when a greater degree of hindfoot correction is attempted.

PMID:35778871 | DOI:10.1177/10711007221108098

AIDS Res Hum Retroviruses. 2022 Jul 1. doi: 10.1089/AID.2022.0006. Online ahead of print.

ABSTRACT

INTRODUCTION: HIV cure research requires interrogating latent HIV reservoirs in deep tissues, which necessitates autopsies to avoid risks to participants. An HIV autopsy biobank would facilitate this research, but such research raises ethical issues and requires participant engagement. This study explores willingness to participate in HIV cure research at the end-of-life.

METHODS: Participants include Canadians with HIV (PWHIV) aged 55 years or older. Following a mixed-method study design, all participants completed a phone or online survey, and a subset of participants participated in in-depth phone or videoconference interviews. We produced descriptive statistics of quantitative data, and a thematic analysis of qualitative data. Barriers and facilitators were categorized under domains of the Theoretical Domains Framework.

RESULTS: From April 2020 to August 2021, 37 participants completed the survey (mean age=69.9 years old; mean duration of HIV infection=28.5 years), including 15 interviewed participants. About three quarters of participants indicated being willing to participate in hypothetical medical studies towards the end-of-life (n=30; 81.1%), in HIV biobanking (n=30; 81.1%), and in a research autopsy (n=28; 75.7%) to advance HIV cure research, mainly for altruistic benefits. Main perceived risks had to do with physical pain and confidentiality. Barriers and facilitators were distributed across five domains: social/professional role and identity, environmental context and resources, social influences, beliefs about consequences and capabilities. Participants wanted more information about study objectives and procedures, possible accommodations with their last will, and rationale for studies or financial interests funding studies.

CONCLUSION: Our results indicate older PWHIV would be willing to participate in HIV cure research towards the end-of-life, HIV biobanking, and research autopsy. However, a dialogue should be initiated to inform participants thoroughly about HIV cure studies, address concerns, and accommodate their needs and preferences. Additional work is required, likely through increased community engagement, to address educational needs.

PMID:35778845 | DOI:10.1089/AID.2022.0006

Med Sci Monit. 2022 Jul 2;28:e936844. doi: 10.12659/MSM.936844.

ABSTRACT

BACKGROUND During the Coronavirus disease 2019 (COVID-19) pandemic, personal protective equipment (PPE) is used during medical resuscitation aerosol-generating procedures (AGP). This simulation study aimed to evaluate the effects of PPE on the performance of emergency resuscitation by medical students from the University of Silesia, Katowice, Poland and non-medical personnel, and used a quality cardiopulmonary resuscitation (Q-CPR) medical manikin. MATERIAL AND METHODS A simulation study was conducted using the Resusci Anne quality cardiopulmonary resuscitation (Q-CPR) medical manikin (Laerdal Medical AS, Norway). Participants were divided into 2 groups: a medical group of 50 and a non-medical group of 52, matched in pairs. Each pair performed 10 min of manual CPR with a compression-ventilation ratio of 30: 2 wearing PPE for AGP. The reference method was manual CPR wearing casual clothes along with surgical masks and latex gloves. Data about compression and ventilation were gathered using the QCPR Training application from Laerdal Medical. RESULTS Data analyses indicated statistically significant differences between medical students using PPE for AGP and basic protection: average rate of chest compressions (123 vs 114 per min; P=0.004), chest recoil (69 vs 93; P=0.0050, correct depth of chest compressions (86.5 vs 97; P=0.0081), quality of ventilation (85 vs 89; P=0.0041). Among non-medical personnel however, a statistically significant difference was in the quality of ventilation (69-85.5; P=0.0032). CONCLUSIONS The findings from this study showed that the use of PPE for AGP during CPR was associated with slower average speed of chest compressions, less chest recoil, incorrect depth of chest compressions, and lower quality of ventilation.

PMID:35778812 | DOI:10.12659/MSM.936844

Ann Otol Rhinol Laryngol. 2022 Jul 1:34894221111097. doi: 10.1177/00034894221111097. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether thyroid nodule surveillance compliance is influenced by patient demographics or plan type.

STUDY DESIGN: Retrospective case series from 2010 to 2018.

SETTING: United States Military Health System.

METHODS: There were 481 patients with a thyroid nodule fine-needle aspiration classified as atypia of undetermined significance for whom treatment and follow-up information were available. Demographic information and surveillance plan type were extracted from the medical record and statistical analysis was performed to determine whether these characteristics influenced compliance rates.

RESULTS: A total of 289 nodules were surveilled and 192 diagnostic lobectomies were performed. An initial surveillance plan was documented in 93% (268/289) and 86% (231/268) complied. The most common plans were repeat biopsy in 78% (210/268) or ultrasound in 20% (53/268). A second plan was documented in 88% (204/231) of those who complied with the first. The most common second plans were ultrasound in 87% (178/204) or repeat biopsy in 8% (17/204). Compliance with the second plan was 64% (130/204), significantly lower than with the first (OR 3.6, 95% CI: [2.3, 5.6], P < .0001). Only 45% (130/289) were surveilled twice. Age and gender did not significantly affect compliance rates. Compliance with primary care ultrasound surveillance was 40% (21/52), significantly lower than with a specialist (77% [137/179]; OR 4.8, 95% CI: [2.5, 9.3, P < .0001).

CONCLUSION: Compliance with surveillance of thyroid nodules classified as atypia of undetermined significance was poor in this military cohort. Ultrasound surveillance by a specialist may be more reliable than with primary care.

PMID:35778811 | DOI:10.1177/00034894221111097

Physiol Rep. 2022 Jul;10(13):e15363. doi: 10.14814/phy2.15363.

ABSTRACT

In humans and animal models, Cesarean section (C-section) has been associated with alterations in the taxonomic structure of the gut microbiome. These changes in microbiota populations are hypothesized to impact immune, metabolic, and behavioral/neurologic systems and others. It is not clear if birth mode inherently changes the microbiome, or if C-section effects are context-specific and involve interactions with environmental and other factors. To address this and control for potential confounders, cecal microbiota from ~3 week old mice born by C-section (n = 16) versus natural birth (n = 23) were compared under matched conditions for housing, cross-fostering, diet, sex, and genetic strain. A total of 601 unique species were detected across all samples. Alpha diversity richness (i.e., how many species within sample; Chao1) and evenness/dominance (i.e., Shannon, Simpson, Inverse Simpson) metrics revealed no significant differences by birth mode. Beta diversity (i.e., differences between samples), as estimated with Bray-Curtis dissimilarities and Aitchison distances (using log[x + 1]-transformed counts), was also not significantly different (Permutational Multivariate ANOVA [PERMANOVA]). Only the abundance of Lachnoclostridium [Clostridium] scindens was found to differ using a combination of statistical methods (ALDEx2, DESeq2), being significantly higher in C-section mice. This microbe has been implicated in secondary bile acid production and regulation of glucocorticoid metabolism to androgens. From our results and the extant literature we conclude that C-section does not inherently lead to large-scale shifts in gut microbiota populations, but birth mode could modulate select bacteria in a context-specific manner: For example, involving factors associated with pre-, peri-, and postpartum environments, diet or host genetics.

PMID:35778808 | DOI:10.14814/phy2.15363

Ann Pharmacother. 2022 Jul 1:10600280221108429. doi: 10.1177/10600280221108429. Online ahead of print.

ABSTRACT

BACKGROUND: Propofol and dexmedetomidine are routinely used in intensive care units (ICUs). Both are lipophilic, potentially leading to accumulation in adipose tissue. Limited evidence exists on what body weight to utilize in patients with morbid obesity.

OBJECTIVE: The purpose of this research was to evaluate the safety and efficacy of weight-based sedation with propofol and dexmedetomidine in ICU patients with morbid obesity.

METHODS: Retrospective review of ICU patients admitted from January 2018 to January 2020 who were sedated for ≥48 hours was performed. The primary outcome was the percentage of time within target sedation during the first 48 hours, stratified by body mass index (BMI) <40 or ≥40 kg/m². Additional outcomes included adverse events and the infusion rate to achieve target sedation. Data were evaluated using descriptive statistics.

RESULTS: A total of 80 patients were analyzed. Patients on propofol with a BMI <40 kg/m² were in their target Richmond Agitation-Sedation Scale (RASS) 11.7% versus 16.1% with a BMI ≥40 kg/m² (P = .580). Patients with a BMI <40 kg/m² on dexmedetomidine were in their target RASS 27.6% versus 10.7% with a BMI ≥40 kg/m² (P = .053).

CONCLUSION AND RELEVANCE: Body mass index did not significantly alter propofol target sedation attainment. However, patients with morbid obesity on dexmedetomidine demonstrated significantly less time in target sedation. An actual body weight dosing strategy of these drugs did not achieve desired target sedation for those with a BMI ≥40 versus BMI <40 kg/m². These findings support future research on the optimal sedation dosing strategy in this patient population.

PMID:35778805 | DOI:10.1177/10600280221108429