Tag: pubmed

J Paediatr Child Health. 2022 Feb 16. doi: 10.1111/jpc.15907. Online ahead of print.

ABSTRACT

AIM: The transition from paediatric to adult care for patients with inflammatory bowel disease (IBD) is associated with an increased risk of treatment non-adherence, hospitalizations and emergency department (ED) use. We established a new young adult IBD clinic (YAC) in Melbourne to capture this at-risk population. We aimed to assess patient satisfaction as well as clinical outcomes.

METHODS: All patients who attended the YAC between its inception in November 2016 and November 2018 were recruited to our YAC group, 61 patients in total. A control group was selected from the pre-existing adult clinic (AC) at our service, 34 patients in total. IBD-related ED (IBD-ED) visits were collected for all patients. We compared IBD-ED visits in the 2 years before and after attending the clinic for the first time. Patient satisfaction was assessed using the IBD-Patient Satisfaction Questionnaire.

RESULTS: There was an overall decrease in IBD-ED visits between the pre-clinic and post-clinic periods in both the YAC (42.9% reduction) and AC (69.2% reduction) (P < 0.001). Patient satisfaction was high amongst both services with YAC patients indicating higher satisfaction with communication (P = 0.015).

CONCLUSION: There was a reduction in IBD-ED visits in both the YAC and the AC, high patient satisfaction, and statistically higher satisfaction with communication in the YAC. We speculate the importance of a YAC is to capture those patients in the peri-transitional period at risk of being lost to follow-up or not previously referred for specialist care.

PMID:35170119 | DOI:10.1111/jpc.15907

J Magn Reson Imaging. 2022 Feb 16. doi: 10.1002/jmri.28107. Online ahead of print.

ABSTRACT

BACKGROUND: Fast 78-second multicontrast echo-planar MRI (EPIMix) has shown good diagnostic performance for detecting infarctions at a comprehensive stroke center, but its diagnostic performance has not been evaluated in a prospective study at a primary stroke center.

PURPOSE: To prospectively determine whether EPIMix was noninferior in detecting ischemic lesions compared to routine clinical MRI.

STUDY TYPE: Prospective cohort study.

POPULATION: A total of 118 patients with acute MRI and symptoms of ischemic stroke.

FIELD STRENGTH AND SEQUENCE: A 3 T. EPIMix (echo-planar based: T1-FLAIR, T2-weighted, T2-FLAIR, T2*, DWI) and routine clinical MRI sequences (T1-weighted fast spin echo, T2-weighted PROPELLER, T2-weighted-FLAIR fast spin echo, T2* gradient echo echo-planar, and DWI spin echo echo-planar).

ASSESSMENT: Three radiologists, blinded for clinical information, assessed signs of ischemic lesions (DWI↑, ADC↓, and T2/T2-FLAIR↑) on EPIMix and routine clinical MRI, with disagreements solved in consensus with a fourth reader to establish the reference standard.

STATISTICAL TESTS: Diagnostic performance including sensitivity and specificity against the reference standard was evaluated. EPIMix sensitivity was tested for noninferiority compared to the reference standard using Nam’s restricted maximum likelihood estimation (RMLE) Score. A P-value < 0.05 was considered statistically significant.

RESULTS: Of 118 patients (mean age 62 ± 16 years, 58% males), 25% (n = 30) had MRI signs of acute infarcts. EPIMix was noninferior with 97% (95% CI 83-100) sensitivity for reader 1, 100% (95% CI 88-100) sensitivity for reader 2, and 90% (95% CI 88-98) sensitivity for reader 3 vs. 93% (95% CI 78-99) sensitivity for readers 1 and 2 and 90% (95% CI 74-98) for reader 3 on routine clinical MRI. Specificity was 99% (95% CI 94-100) for reader 1, 100% (95% CI 96-100) for reader 2, and 98% (95% CI 92-100) for reader 3 on EPIMix vs. 100% (95% CI 96-100) for all readers on routine clinical MRI.

CONCLUSION: EPIMix was noninferior to routine clinical MRI for the diagnosis of acute ischemic stroke.

EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

PMID:35170134 | DOI:10.1002/jmri.28107

Crim Behav Ment Health. 2022 Feb 15. doi: 10.1002/cbm.2230. Online ahead of print.

ABSTRACT

BACKGROUND: As incarcerated populations report significantly higher prevalence rates for psychological distress than community populations, it is important to have an evidence-based perspective on what reduces psychological distress among people in prison or jail.

AIMS: To examine effects of mindfulness-based interventions (MBIs) on psychological distress, including anxiety, depressive symptoms, stress and overall psychological distress, and on mindfulness in incarcerated populations.

METHODS: This systematic review and meta-analysis of randomised controlled trials (RCTs) involved a comprehensive search within the PubMed, CINAHL, PsycINFO, and SCOPUS databases to identify relevant RCTs. The quality of the included RCTs was assessed using the Cochrane Collaboration risk of bias tool. Depending on I² statistic values for heterogeneity, either a random effects model or fixed effects model was used. Subgroup analyses for each outcome were conducted to see whether effects differed when compared MBIs to active control groups, provided with other comparable interventions, or passive control groups, provided with no intervention (i.e., treatment as usual [TAU] control groups or waiting list controls).

RESULTS: Thirteen RCTs met the eligibility criteria. Meta-analyses showed moderate effects of MBIs on depressive symptoms and overall psychological distress, large effects on stress, and small effects on anxiety and mindfulness. The overall risk of bias across studies was unclear. Fewer studies were conducted to compare effects of MBIs to other interventions than TAU.

CONCLUSIONS: Future high-quality studies comparing MBIs to other active interventions are needed to understand better whether the former are comparable or superior to other evidence-based treatments in decreasing distress and improving mindfulness in incarcerated populations and/or in which circumstances one may be preferable to the other.

PMID:35170107 | DOI:10.1002/cbm.2230

Acta Paediatr. 2022 Feb 16. doi: 10.1111/apa.16292. Online ahead of print.

ABSTRACT

Asthma prevalence in Australian children is amongst the highest in the world. Monoclonal antibody treatments (biologics) are the fifth step in the Global Initiative for Asthma guidelines to treat severe asthma. Our retrospective cohort study aimed to evaluate the effect of biologics for children with severe asthma, assess adherence and explore attitudes toward home administration using prefilled injection devices. We collected data for paediatric patients receiving biologics to compare asthma-related outcomes six-months pre and post initiation of therapy. Participant and parent surveys assessed perceived change in asthma control and attitudes to home injections. Eleven patients were recruited. Six-months post biologic treatment there were significant reductions in mean exhaled nitric oxide (-40ppb, p<0.05) and asthma control questionnaire 5 (ACQ-5) (-1.7, p<0.05). The mean number of hospitalisations and OCS courses were also less, although not statistically significant (p=0.53 and 0.17 respectively). There were no notable changes in mean percent-predicted FEV1, FVC or FEV1/FVC. 80% of patients and carers perceived slightly or much better asthma control on biologics and 80% of carers indicated they would be slightly or much happier with home-based injections. We conclude that biologics can improve asthma control. Whilst health-centre injections adherence is high, carers are interested in home injections.

PMID:35170088 | DOI:10.1111/apa.16292

J Adv Nurs. 2022 Feb 15. doi: 10.1111/jan.15182. Online ahead of print.

ABSTRACT

AIM: To gain insight into which elements of the interpersonal care relationship (IPCR) are perceived as occurring (less) frequently and as (not) disturbing from the perspective of hospitalized older patients.

DESIGN: A cross-sectional study in three Belgian hospitals.

METHODS: A convenience sample of patients aged 75 years or older admitted to a non-geriatric ward were recruited between May 2017 and April 2019. The Interpersonal Geriatric care relationship (InteGer) tool was used to identify elements of the IPCR and was completed by the researchers through structured patient interviews.

RESULTS: The mean total scale score for frequency was 3.74 (SD 1.51) [range 0-12]. On subscale level, the highest mean score was in the accessibility and the lowest mean score in the humanization subscale. Statistically significant differences between the hypothesized and experienced disturbance were observed in 18 of the 30 items. Ten items score in the category ‘no action needed’ (not occurring, not disturbing), nine items in the category ‘remain attentive for patient experiences’ (occurring, not disturbing), 10 items in the category ‘further analyses or monitoring needed’ (not occurring, disturbing) and one item in the category ‘urgent action needed’ (occurring and disturbing).

CONCLUSION: Participants report mostly positive experiences related to the four subscales of the InteGer, that is, humanization, attentiveness, interest and accessibility. Insights from this study provide important opportunities in the context of care optimization for each category with the main focus on items with high experienced disturbance.

IMPACT: The InteGer can be used for monitoring IPCR and formulating action points at ward and hospital level to further improve the IPCR and quality of care.

PMID:35170094 | DOI:10.1111/jan.15182

Int J Geriatr Psychiatry. 2022 Mar;37(3). doi: 10.1002/gps.5695.

ABSTRACT

OBJECTIVE: Delirium is a common postoperative complication of hip fracture. Various methods exist to detect delirium as a reference standard. The goal of this study was to characterize the properties of the measures obtained in a randomized controlled trial, to document their relationship to the Diagnostic and Statistical Manual of Mental Disorders:Text Revision based diagnosis of postoperative delirium by a consensus panel, and to describe the method in detail to allow replication by others.

METHODS: A secondary analysis of the randomized trial STRIDE (A Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients) was conducted. Delirium assessments were performed in 200 consecutive hip fracture repair patients ≥65 years old. Assessors underwent extensive training in delirium assessment and the final delirium diagnosis was adjudicated by a consensus panel of three physicians with expertise in delirium assessment.

RESULTS: A total of 680 consensus panel delirium diagnoses were completed. There were only 19 (2.8%, 19/678) evaluations where the delirium adjudication by the consensus panel differed from delirium findings by the Confusion Assessment Method (CAM). In 16 (84%, 16/19) of the cases, CAM was negative but the consensus panel diagnosed the patient as having delirium based on all of the available information including the CAM.

CONCLUSION: The consensus panel diagnosis was more sensitive compared to CAM alone, however the magnitude of the difference was not large. When assessors are well trained and delirium assessments are closely supervised throughout the study, CAM may be adequate for delirium diagnosis in a clinical trial. Future studies are needed to test this hypothesis.

PMID:35170079 | DOI:10.1002/gps.5695

Dev Med Child Neurol. 2022 Feb 15. doi: 10.1111/dmcn.15175. Online ahead of print.

ABSTRACT

AIM: To determine the relationship between motor abilities and intelligence in children and young people with prenatal alcohol exposure (PAE) being assessed for fetal alcohol spectrum disorder (FASD).

METHOD: This was a cross-sectional correlational study of children and young people with PAE being assessed for FASD. The relationship between motor abilities (Movement Assessment Battery for Children, Second Edition) and intelligence (Wechsler Intelligence Scale for Children, Fourth or Fifth Edition) was calculated using correlation and regression analyses. Attention and executive function were considered as potential confounding variables.

RESULTS: The relationship between motor abilities and intelligence in 73 children and young people (48 males, 25 females; aged 6-17y, mean age 10y 5mo [SD 2y 9mo]) assessed for FASD was small and statistically non-significant (r=0.05, p=0.67).

INTERPRETATION: The findings confirm that motor abilities and intelligence should be assessed separately when investigating an FASD diagnosis. Intelligence scores should not be used to estimate motor abilities, nor should they dictate when motor testing be completed. Assessing intelligence and motor domains separately will enhance diagnostic accuracy, identify the need for strategies or interventions to address functional motor skills, and further define the role of physiotherapy and occupational therapy in FASD assessment and intervention.

PMID:35170025 | DOI:10.1111/dmcn.15175

Transfusion. 2022 Feb 16. doi: 10.1111/trf.16831. Online ahead of print.

ABSTRACT

BACKGROUND/CASE STUDIES: Optimizing a hospital blood inventory requires understanding the distribution of blood usage at the institution. Standard methods for describing red blood cell (RBC) usage like mean and standard deviation assume a normal distribution. Other distributions may fit the distribution of daily RBC usage better and provide more accurate insights into blood usage and in6ventory management.

STUDY DESIGN/METHODS: RBC usage data from 2014 through 2020 were queried from the laboratory information system. Theoretical distributions were fit against this empirical distribution of daily RBC usage. Goodness-of-fit was assessed visually using Pearson/Cullen and Frey plots as well as quantitatively using Kolomogorov-Smirnov (K-S) distance and the Akaike Information Criterion (AIC).

RESULTS/FINDINGS: 241,957 units of RBCs were transfused over 2557 days in the study period. The log-normal and gamma distributions had superior K-S distances and AICs for daily RBC usage. The top percentile of days for RBC usage was significantly more likely to have at least one ultramassively transfused patient (p < .001, Fisher’s Exact Test).

CONCLUSIONS: The log-normal and gamma distributions better describe the right-skewed and entirely positive empirical distribution of daily RBC usage as compared to the normal distribution. This should broadly inform inventory management efforts and future descriptions of RBC usage at the institutional level.

PMID:35170040 | DOI:10.1111/trf.16831

Clin Pharmacol Ther. 2022 Feb 16. doi: 10.1002/cpt.2560. Online ahead of print.

ABSTRACT

As the scientific research community along with health care professionals and decision-makers around the world fight tirelessly against the COVID-19 pandemic, the need for comparative effectiveness research (CER) on preventive and therapeutic interventions for COVID-19 is immense. Randomized controlled trials markedly underrepresent the frail and complex patients seen in routine care, and they do not typically have data on long-term treatment effects. The increasing availability of electronic health records (EHRs) for clinical research offers the opportunity to generate timely real-world evidence reflective of routine care for optimal management of COVID-19. However, there are many potential threats to the validity of CER based on EHR data that are not originally generated for research purposes. To ensure unbiased and robust results, we need high-quality healthcare databases, rigorous study designs, and proper implementation of appropriate statistical methods. We aimed to describe opportunities and challenges in EHR-based CER for COVID-19-related questions and to introduce best practices in pharmacoepidemiology to minimize potential biases. We structured our discussion into the following topics: 1) Study population identification based on exposure status; 2) Ascertainment of outcomes; 3) Common biases and potential solutions; and 4) Data operational challenges specific to COVID-19 CER using EHR. We provide structured guidance for the proper conduct and appraisal of drug and vaccine effectiveness and safety research using EHR data for the pandemic. This manuscript is endorsed by the International Society for Pharmacoepidemiology (ISPE).

PMID:35170021 | DOI:10.1002/cpt.2560

Atten Percept Psychophys. 2022 Feb 15. doi: 10.3758/s13414-021-02407-w. Online ahead of print.

ABSTRACT

An ensemble or statistical summary can be extracted from facial expressions presented in different spatial locations simultaneously. However, how such complicated objects are represented in the mind is not clear. It is known that the aftereffect of facial expressions, in which prolonged viewing of facial expressions biases the perception of subsequent facial expressions of the same category, occurs only when a visual representation is formed. Using this methodology, we examined whether an ensemble can be represented with visualized information. Experiment 1 revealed that the presentation of multiple facial expressions biased the perception of subsequent facial expressions to less happy as much as the presentation of a single face did. Experiment 2 compared the presentation of faces comprising strong and weak intensities of emotional expressions with an individual face as the adaptation stimulus. The results indicated that the perceptual biases were found after the presentation of four faces and a strong single face, but not after the weak single face presentation. Experiment 3 employed angry expressions, a distinct category from the test expression used as an adaptation stimulus; no aftereffect was observed. Finally, Experiment 4 clearly demonstrated the perceptual bias with a higher number of faces. Altogether, these results indicate that an ensemble average extracted from multiple faces leads to the perceptual bias, and this effect is similar in terms of its properties to that of a single face. This supports the idea that an ensemble of faces is represented with visualized information as a single face.

PMID:35169990 | DOI:10.3758/s13414-021-02407-w