Tag: pubmed

Zhongguo Zhong Yao Za Zhi. 2021 Nov;46(22):5958-5976. doi: 10.19540/j.cnki.cjcmm.20210408.501.

ABSTRACT

To systematically evaluate the clinical efficacy of 14 oral Chinese patent medicines combined with Azithromycin in the treatment of mycoplasma pneumonia in children with network Meta-analysis. Computer retrieval was performed for such databases as CNKI, VIP, Wanfang, CBM, PubMed, EMbase and Cochrane Library to screen out randomized controlled trials of oral Chinese patent medicines combined with Azithromycin in the treatment of mycoplasma pneumonia in children from the time of database establishment to September 2020. The included studies were evaluated by the Cochrane Risk Assessment tool. Stata 14.0 and Review Manager 5.3 software were used for data statistical analysis. A total of 60 RCTs were included in this study, involving 14 oral Chinese patent medicines. The efficacy ranking based on network Meta-analysis was as follows:(1)in terms of total effective rate, top five Chinese patent medicines in surface under the cumulative ranking curve(SUCRA) were Xiao’er Xiaoji Zhike Oral Liquid, Xiao’er Chiqiao Qingre Granules, Xiao’er Feike Granules, Pudilan Xiaoyan Oral Liquid and Lanqin Oral Liquid;(2)in terms of antifebrile time, top five Chinese patent medicines in SUCRA were Huaiqihuang Granules, Xiao’er Magan Granules, Xiao’er Kechuanling Granules/Oral Liquid, Shuanghuang-lian Oral Liquid for children and Xiao’er Xiaoji Zhike Oral Liquid;(3)in terms of cough disappearance time, top five Chinese patent medicines in SUCRA were Xiao’er Magan Granules, Huaiqihuang Granules, Xiao’er Chiqiao Qingre Granules, Xiao’er Feire Kechuan Oral Liquid and Xiao’er Kechuanling Granules/Oral Liquid;(4)in terms of rale disappearance time, top five Chinese patent medicines in SUCRA were Xiao’er Magan Granules, Huaiqihuang Granules, Xiao’er Feire Kechuan Oral Liquid, Shuanghuanglian Oral Liquid for children and Yupingfeng Granules. The results showed that on the basis of the use of Azithromycin, combined administration with oral Chinese patent medicines could improve the overall clinical efficacy in the treatment of mycoplasma pneumonia in children. However, due to the large differences in the quality and the number of included studies among various therapeutic measures, the ranking results of SUCRA of Chinese patent medicines need to be verified by high-quality multi-center, large-sample, randomized double-blind trials in the future.

PMID:34951188 | DOI:10.19540/j.cnki.cjcmm.20210408.501

J Dent Educ. 2021 Dec 23. doi: 10.1002/jdd.12854. Online ahead of print.

ABSTRACT

INTRODUCTION: Harassment is an issue that occurs in all workplaces and institutions. Due to increased exposure to patients, higher rates of harassment are experienced in health care systems. Health care workers need to form a professional relationship with patients to attend to their health care needs; however, harassment by patients can disrupt this relationship and have detrimental physical, mental, and emotional impacts on the health practitioner.

OBJECTIVE: The purpose of this study was to examine the prevalence and impact of harassment by patients toward clinical students at a prominent Australasian dental school.

METHODS: A 14-item survey was distributed to clinical students. The survey collected basic demographic information and contained Likert-scale closed questions on harassment prevalence and experience and a free text question asking for details of a significant harassment experience. Descriptive statistics and analysis of free text data were performed.

RESULTS: The response rate was 67%. About 20% of respondents reported experiencing at least one incident of harassment. Verbal harassment was most commonly reported, followed by sexual and racial harassment. All incidences of sexual harassment were reported by female students, while racial harassment was most frequently reported by students of Asian ethnicity. Most students indicated they were unsure of how to respond to harassment by patients.

CONCLUSION: Dental students were exposed to harassment by patients.

IMPLICATIONS: Appropriate policies and education on responding to harassment, alongside support for the same, could help ensure the safety and wellbeing of students.

PMID:34951016 | DOI:10.1002/jdd.12854

Int J Gynaecol Obstet. 2021 Dec 23. doi: 10.1002/ijgo.14082. Online ahead of print.

ABSTRACT

INTRODUCTION: Very low birthweight (VLBW) is a multifactorial etiology public health problem that includes poverty and violence aspects. The study aimed to determine the association between armed conflict and VLBW.

MATERIAL AND METHODS: Case-control population study matched by year of delivery conducted in Cauca, Colombia, between 2010 and 2016. Cases of VLBW, with weights between 500-1,499 g and controls weighing between 2,500-3,999 g. Cases and controls were identified through the vital statistics registry, and exposure was determined using a multidimensional index designed by the Colombian State. Multiple gestations were excluded. Conditional logistic regression for matched data was used, adjusting for confounding variables.

RESULTS: Overall, 7,068 matched participants (1,767 cases and 5,301 controls) were included. Cases and controls had similar baseline characteristics. Participants were predominantly women in the second and third decades of life, 46% were exposed to armed conflict, and 25% were of African-Colombian or indigenous ethnicity. Maternal exposure to armed conflict significantly increased the odds of VLBW among women with rural birth (aOR 3.86; 95%CI 2.74-5.45) and inadequate prenatal care (aOR 10.38; 95%CI 8.20-13.12).

CONCLUSIONS: Exposure to armed conflict increases the odds of VLBW neonates. This factor needs to be considered in prenatal care.

PMID:34951010 | DOI:10.1002/ijgo.14082

AAPS PharmSciTech. 2021 Dec 23;23(1):34. doi: 10.1208/s12249-021-02189-2.

ABSTRACT

Skin ulcers have increased sharply due to rise in the incidence of obesity and diabetes. This study investigated lipid nanocarriers as a strategy to improve the efficacy of levofloxacin (LV) in penetrating skin. Two surfactant types and different lipid mixtures were used in preparation of lipid nanocarriers. Mean particle size, percentage entrapment efficiency (%EE), in vitro release, and antimicrobial activity were examined. The selected formula was incorporated into a chitosan (CS) film that was subjected to physic-chemical characterization and ex vivo permeation study. The selected formula showed particle size, PDI, and ZP: 80.3 nm, -0.21, and -26 mV, respectively, synchronized with 82.12 %EE. In vitro release study showed slow biphasic release of LV from lipid nanocarriers. The antimicrobial effect illustrated statistically significant effect of lipid nanocarriers on decreasing the minimum effective concentration (MIC) of LV, particularly against E. coli. The optimized nanocarriers’ formula loaded into CS film was clear, colorless, translucent, and smooth in texture. Based on the release profiles, it could be speculated that the CS film loaded with LV nanocarriers can maintain the antibacterial activity for 4 consecutive days. Thus, the local delivery of the drug in a sustained release manner could be predicted to enhance the therapeutic effect. Further clinical studies are strongly recommended. Graphical Abstract.

PMID:34950989 | DOI:10.1208/s12249-021-02189-2

Mil Med. 2021 Dec 24:usab526. doi: 10.1093/milmed/usab526. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this quality improvement project was to develop and evaluate the use of an electronic medication request dashboard to reduce the amount of time required for medication processing and decrease time lost to workflow interruptions during patient discharge. Delayed discharges are associated with increased health care costs and adverse patient outcomes. Processing of medication requests at discharge contributes to these delays and to workflow interruptions for nursing and pharmacy staff at the project site. Electronic dashboards have been successfully implemented in multiple medical settings to streamline patient processing and enhance communication.

MATERIALS AND METHODS: The Human Protections Office at Carl R. Darnall Army Medical Center (Fort Hood, TX) reviewed and approved the project with a non-human research determination. A multi-disciplinary workgroup with representatives from nursing, pharmacy, and health information technology (HIT) was formed to develop the dashboard. Based on a logic flow diagram of the desired communication, HIT created a medication request form and status dashboard using SharePoint and Nintex workflows. The dashboard was implemented for a 30-day pilot on a 25-bed medical/surgical nursing unit. The time required for medication processing, the time from discharge order to patient exit, the number of phone calls between nursing and pharmacy, and the usability of the medication request process were measured before and after implementation. The results were analyzed with descriptive statistics and evaluated for statistical significance with a P value ≤.05.

RESULTS: With implementation of the dashboard, the average medication processing time decreased from 125 minutes to 48 minutes (P < .0001), and the average patient discharge time decreased from 137 minutes to 117 minutes (P = .002). The usability score of the medication request process increased from 40 to 87 for nursing (P < .0001) and from 62 to 85 for pharmacy (P = .003). The total number of voice calls between nursing and pharmacy decreased from 1,115 to 434, while the total time on voice calls decreased from 33 hours and 50 minutes to 13 hours and 19 minutes (P < .0001).

CONCLUSIONS: The electronic dashboard is an effective method to enhance interdisciplinary communication during patient discharge and significantly reduces medication processing times. However, despite the medication processing time decreasing by over an hour, the discharge time only decreased by 20 minutes. Additional investigation is needed to evaluate other contributors to delayed discharge. A key limitation of this study was the convenience sampling used over a 30-day pilot on a single unit. The process has since been adopted by the entire hospital, and additional analysis could better reveal the impact to the organization. This communication system shows high usability and reduces phone call interruptions for both nursing and pharmacy staff. Additionally, this technology could easily be applied to other communication pathways or request processes across military medicine.

PMID:34950952 | DOI:10.1093/milmed/usab526

Mil Med. 2021 Dec 24:usab519. doi: 10.1093/milmed/usab519. Online ahead of print.

ABSTRACT

INTRODUCTION: Computed tomography (CT) Hounsfield units (HU) recently emerged as a promising screening tool for low bone mineral density (BMD). We hypothesized that CT HU measurements of the thoracic spine would significantly and positively correlate with dual X-ray absorptiometry (DXA) BMD scans of the femoral neck.

MATERIALS AND METHODS: The study included patients with DXA scans and thoracic CT scans at the Walter Reed National Military Medical Center. One author, blinded to the DXA scans, measured HU from the cancellous bone in T4 vertebrae. Another author statistically compared femoral neck DXA T-scores to the CT HU measurements.

RESULTS: The study included 145 patients with CT scans and femoral neck DXAs. The osteoporotic and osteopenic groups had a significant difference in HU measurements compared to the normal group within the study (P < .0001 and .002, respectively). A low BMD screening value of 231 HU provided a sensitivity of 90.1% and negative predictive value of 85.7%.

CONCLUSION: Thoracic vertebrae HU measurements correlate with a low BMD of the femoral neck as determined by DXA T-scores. A high sensitivity and negative predictive value was achieved with a screening value of 231 HU. Utilization of chest or thoracic spine CT imaging as a screening method provides a quick and available screening tool for assessing low BMD in patients with these scans.Level of Evidence: III (Diagnostic).

PMID:34950956 | DOI:10.1093/milmed/usab519

Mil Med. 2021 Dec 24:usab520. doi: 10.1093/milmed/usab520. Online ahead of print.

ABSTRACT

INTRODUCTION: Airway obstruction is the third most common cause of preventable death on the battlefield, accounting for 1%-2% of total combat fatalities. No previous surgical cricothyroidotomy (SC) studies have analyzed the learning curve required to obtain proficiency despite being studied in numerous other surgical technique training experiments. The aims of this study were to establish expert SC performance criteria, develop a novel standardized SC curriculum, and determine the necessary number of practice iterations required by a novice to reach this pre-determined performance goal.

MATERIALS AND METHODS: A standardized checklist and SC performance standards were established based on the performance of 12 board certified Military Health System surgeons with prior experience on performing a SC using a simulated trauma mannequin. Expert-level criteria were defined as a SC time to completion of 40 s or less and checklist score of at least 9/10, including all critical steps. Study subjects included 89 novice providers (54 active-duty first- and second-year medical students and 35 Navy corpsmen). Subjects received instruction on performing a SC using the principles of mastery learning and performed a final test of SC proficiency on a trauma mannequin within a realistic simulated MEDEVAC helicopter. The total number of subject practice attempts, checklist scores, and time to completion were measured and/or blindly scored. Learning curve and exponential plateau equations were used to characterize their improvement in mean time to SC completion and checklist scores.

RESULTS: Mean pre-test knowledge scores for the entire group were 11.8 ± 3.1 out of 24 points. Total mean practice learning plateaued at checklist scores of 9.9/10 after 7 iterations and at a mean completion time of 30.4 s after 10 iterations. During the final test performance in the helicopter, 67.4% of subjects achieved expert-level performance on the first attempt. All subjects achieved expert-level performance by the end of two additional attempts. While a significantly larger proportion of medical students (79.9%) successfully completed the helicopter test on the first attempt compared to corpsmen (54.3%), there were no statistically significant differences in mean SC completion times and checklist scores between both groups (P > 0.05). Medical students performed a SC only 1.3 s faster and scored only 0.16 points higher than corpsmen. The effect size for differences were small to negligible (Cohen’s d range 0.18-0.33 for SC completion time; Cohen’s d range 0.45-0.46 for checklist scores).

CONCLUSION: This study successfully defined SC checklist scores and completion times based on the performance of experienced surgeons on a simulator. Using these criteria and the principles of mastery learning, novices with little knowledge and experience in SC were successfully trained to the level of experienced providers. All subjects met performance targets after training and overall performance plateaued after approximately seven iterations. Over two-thirds of subjects achieved the performance target on the first testing attempt in a simulated helicopter environment. Performance was comparable between medical student and corpsmen subgroups. Further research will assess the durability of maintaining SC skills and the timing for introducing refresher courses after initial skill acquisition.

PMID:34950946 | DOI:10.1093/milmed/usab520

Clin Infect Dis. 2021 Dec 24:ciab1047. doi: 10.1093/cid/ciab1047. Online ahead of print.

ABSTRACT

BACKGROUND: Household contact tracing for tuberculosis (TB) may facilitate TB diagnosis and identify individuals who may benefit from TB preventive therapy (TPT). In this cluster-randomised trial, we investigated whether household contact tracing and intensive TB/HIV screening would improve TB-free survival.

METHODS: Household contacts of index TB patients in two Provinces of South Africa were randomised to home tracing and intensive HIV/TB screening (sputum Xpert and culture; HIV testing with treatment linkage; and TPT, if eligible), or standard of care (SOC, clinic referral letters). The primary outcome was incident TB or death at 15-months. Secondary outcomes included tuberculin skin test (TST) positivity in children ≤14 years and undiagnosed HIV. (ISRCTN16006202).

RESULTS: From December 2016-March 2019, 1,032 index patients (4,459 contacts) and 1,030 (4,129 contacts) were randomised to the intervention and SOC arms. 3.2% (69/2166) of intervention arm contacts had prevalent microbiologically-confirmed TB. At 15-months, the cumulative incidence of TB or death did not differ between the intensive screening (93/3230, 2.9%) and SOC (80/2600, 3.1%) arms (hazard ratio: 0.90, 95% confidence interval (CI): 0.66-1.24). TST positivity was higher in the intensive screening arm (38/845, 4.5%) compared to the SOC arm (15/800, 1.9%, odds ratio: 2.25, 95% CI: 1.07-4.72). Undiagnosed HIV was similar between arms (41/3185, 1.3% vs. 32/2543, 1.3%; odds ratio: 1.02, 95% CI: 0.64-1.64).

CONCLUSIONS: Household contact tracing with intensive screening and referral did not reduce incident TB or death. Providing referral letters to household contacts of index patients is an alternative strategy to home visits in high TB/HIV-prevalence settings.

PMID:34950944 | DOI:10.1093/cid/ciab1047

J Gerontol A Biol Sci Med Sci. 2021 Dec 24:glab382. doi: 10.1093/gerona/glab382. Online ahead of print.

ABSTRACT

This review identifies frequent design and analysis errors in aging and senescence research and discusses best practices in study design, statistical methods, analyses, and interpretation. Recommendations are offered for how to avoid these problems. The following issues are addressed: 1) errors in randomization, 2) errors related to testing within-group instead of between-group differences, 3) failing to account for clustering, 4) failing to consider interference effects, 5) standardizing metrics of effect size, 6) maximum lifespan testing, 7) testing for effects beyond the mean, 8) tests for power and sample size, 9) compression of morbidity versus survival curve-squaring, and 10) other hot topics, including modeling high-dimensional data and complex relationships and assessing model assumptions and biases. We hope that bringing increased awareness of these topics to the scientific community will emphasize the importance of employing sound statistical practices in all aspects of aging and senescence research.

PMID:34950945 | DOI:10.1093/gerona/glab382

Patterns (N Y). 2021 Dec 10;2(12):100393. doi: 10.1016/j.patter.2021.100393. eCollection 2021 Dec 10.

ABSTRACT

The paper highlights how each step of a data science pipeline can be performed in a “responsible” way, taking into account privacy, ethics, and quality issues. Several examples from the Italian public sector contribute to clarifying how data collections and data analyses can be carried out under a responsible view.

PMID:34950908 | PMC:PMC8672189 | DOI:10.1016/j.patter.2021.100393