Tag: pubmed

Int J Nurs Stud. 2022 Jan 10;129:104173. doi: 10.1016/j.ijnurstu.2022.104173. Online ahead of print.

ABSTRACT

BACKGROUND: Both globally and nationally, determinants of end-of-life care practices in nursing homes, such as laws and workforce, vary widely, resulting in a huge disparity in the quality of such practices. Despite the rapid growth in the number of nursing homes and increasing social attention being paid to end-of-life care in South Korea, little is known about these practices and how they differ because of nursing home-related regulations and nurse staffing.

OBJECTIVES: To examine end-of-life care practices in nursing homes and compare them between nursing homes with 30 beds or more and those with fewer than 30 beds (the cut-point where nursing home-related regulations differ) and between nursing homes with and without registered nurses.

DESIGN: A cross-sectional exploratory study using data from a national survey conducted by the National Health Insurance Service.

SETTINGS: Nursing homes certified by the national long-term care insurance in South Korea.

PARTICIPANTS: Nursing representatives from 836 nursing homes.

METHODS: Measures of end-of-life care practices included the identification of residents’ (or families’) preferences for the place of death and a do-not-resuscitate order, the provision of end-of-life care on-site, and the presence of end-of-life care protocols. Descriptive statistics and logistic regression were used to compare end-of-life care practices by bed size and registered-nurse staffing.

RESULTS: Of the 836 nursing homes, 85% and 84.1% identified the preference for the place of death and a do-not-resuscitate order mostly from surrogates, respectively. The most preferred places of death were nursing homes (53.3%) and hospitals (46.0%). Approximately, 72% responded that on-site end-of-life care protocols were present, and 50.8% reported providing end-of-life care on-site. Compared to nursing homes with 10-29 beds, those with 30 beds or more were more likely to identify the preference for a do-not-resuscitate order (OR 2.392, 95% CI 1.643-3.482); have in place end-of-life care protocols (OR 1.829, 95% CI 1.341-2.496); and provide end-of-life care on-site (OR 1.556, 95% CI 1.169-2.072). Compared to nursing homes without registered nurses, those with registered nurses were also more likely to identify the preference for a do-not-resuscitate order (OR 1.717, 95% CI 1.142-2.583) and provide end-of-life care on-site (OR 1.663, 95% CI 1.254-2.206).

CONCLUSIONS: The findings indicate a huge disparity in end-of-life care practices in nursing homes across South Korea by bed size-based nursing-home regulations and registered-nurse staffing. Law/regulation- and policy-level changes are needed to promote robust end-of-life care in nursing homes.

STUDY REGISTRATION: Not registered.

PMID:35299051 | DOI:10.1016/j.ijnurstu.2022.104173

Breast. 2022 Feb 21;63:37-45. doi: 10.1016/j.breast.2022.02.012. Online ahead of print.

ABSTRACT

INTRODUCTION: Factors influencing breast reconstruction rates in Canada are complex and multi-factorial, ranging from patient-related to systemic considerations. For plastic surgeons, rates of immediate breast reconstruction (IBR) hinge on referral patterns from general surgeons performing breast cancer surgery and informed discussions with patients about their goals and risk tolerance. We seek to understand the reasons Alberta patients are not receiving IBR as reported by general surgeons.

METHODS: The Synoptec™ database is a synoptic operative report designed by Cancer Surgery Alberta™ and utilized by 95% of Alberta breast cancer surgeons. Within this report are mandatory questions regarding if a patient is receiving IBR and, if not, why. A retrospective review of this database was performed for all patients undergoing surgical treatment of breast cancer over two years. All statistical comparisons were made using chi-squared test for categorical variables with a p-value of 0.05 considered significant.

RESULTS: Of 6253 patients undergoing breast cancer surgery, 2649 underwent mastectomy and 615 mastectomy patients received IBR. The most commonly reported reasons patients did not undergo IBR were patient preference (55%), high likelihood of postoperative radiation therapy (20%), and high risk due to patient co-morbidities (12%). Resource limitations (2%) and a lack of an IBR discussion (3%) was rarely cited as reasons for no IBR.

CONCLUSIONS: There are many reconstructive options following mastectomy in breast cancer survivors. This study provides a unique look into general surgeon reported reasons patients are not receiving IBR and demonstrates the need for further probing into the thought-process behind these reported reasons from both a surgeon and patient perspective.

PMID:35299033 | DOI:10.1016/j.breast.2022.02.012

Breast. 2022 Mar 12;63:29-36. doi: 10.1016/j.breast.2022.03.006. Online ahead of print.

ABSTRACT

PURPOSE: Young age is associated with poor prognosis in ductal carcinoma in situ (DCIS) of female breast and controversy exists regarding the optimal treatment modality for young patients. We aimed to compare treatment outcomes among breast conserving surgery (BCS), BCS with adjuvant radiotherapy (BCS + RT), and total mastectomy (MT) for young DCIS women.

METHODS: PubMed, Cochrane, and Embase were searched for studies reporting comparative results among BCS, BCS + RT, or MT in ≤50 years old (y/o) DCIS females. Study quality was assessed and meta-analysis with subgroup analysis was performed to pool the effect sizes of the outcomes-of-interest.

RESULTS: We included 3 randomized control trials and 18 observational studies. For DCIS women ≤50 y/o, RT following BCS significantly reduced the risk for ipsilateral breast tumor recurrence (IBTR) (HR = 0.66, 95% CI 0.50-0.87). However, the benefit was less robust in extremely young patients and with long follow-ups. RT revealed no statistically significant preventive effect on ipsilateral invasive recurrence (HR = 1.38, 95% CI 0.98-1.94). On the other hand, MT yielded the lowest IBTR (BCS + RT vs MT: HR = 4.4, 95% CI 2.06-9.40), both in ipsilateral DCIS recurrence and ipsilateral invasive recurrence. There was great heterogeneity and could not reach an evident conclusion concerning survival outcomes.

CONCLUSION: This study highlighted the varying effect of RT for young DCIS females. The local control benefit of MT was definite without survival differences observed. Our study provided a moderate certainty of evidence to guide the treatment for young DCIS women. Further age-specific prospective trial is warranted.

PMID:35299032 | DOI:10.1016/j.breast.2022.03.006

Int J Obstet Anesth. 2022 Feb 17;50:103271. doi: 10.1016/j.ijoa.2022.103271. Online ahead of print.

ABSTRACT

BACKGROUND: Uterine positioning during hysterotomy repair is controversial, with both in situ and externalized approaches commonly performed. Despite many published trials, clinical equipoise remains. This meta-analysis and trial sequential analysis (TSA) summarizes studies comparing both techniques.

METHODS: A systemic search for randomized controlled trials comparing in situ with externalized hysterotomy repair during cesarean delivery was performed. The primary outcomes were estimated blood loss (EBL) and surgical duration. Secondary outcomes were need for blood transfusion, incidence of endometritis, hospital length of stay, intra-operative hypotension, return of bowel function, intra-operative vomiting, intra-operative pain, and need for postoperative analgesia. Cochrane methodology was used to assess risk of bias. Data are presented as mean difference/standardized mean difference or odds ratio/risk difference with 95% confidence intervals (CI).

RESULTS: Nineteen studies enrolling 20 739 patients were included. Estimated blood loss and surgical duration were equivalent between methods, with TSA confirming adequate information size for surgical duration but not EBL. In situ repair was associated with faster return of bowel function (MD, -0.76 days; 95% CI, -1.36 to -0.15; P=0.01) and a reduction in need for breakthrough postoperative analgesia (OR, 0.44; 95% CI, 0.28 to 0.68; P <0.01).

CONCLUSIONS: This analysis revealed equivalence between methods for EBL and surgical duration. While the small reduction in EBL with externalized repair was not clinically or statistically significant, TSA analysis revealed an unmet information size, suggesting a potentially inconclusive result. In situ repair may be associated with less breakthrough postoperative analgesia requirement and faster return of bowel function.

PMID:35299027 | DOI:10.1016/j.ijoa.2022.103271

J Biomech. 2022 Mar 10;135:111035. doi: 10.1016/j.jbiomech.2022.111035. Online ahead of print.

ABSTRACT

Exercise encourages active and healthy aging, maintaining functional and physical capabilities. This study aimed to assess the effects of a long-term moderate aerobic exercise protocol on bone microarchitecture and fragility associated with chronic inflammation and oxidative stress in aging. Male BALB/c mice (n = 10 per group) underwent a moderate exercise protocol from 13 weeks to 27 (adulthood age) or 108 weeks of age (elderly age) and were then sacrificed. Age-match sedentary mice were included as a control group. Serum cortisol concentrations were determined by chemiluminescent immunoassay, C-reactive protein (CRP) by a turbidimetric assay, advanced glycation end-products (AGEs) and malondialdehyde (MDA) by fluorescent spectroscopy, and total glutathione (GSH) by colorimetric method. The right femur was dissected formorphometric and densitometricanalysis bycomputerized microtomography (µCT),and biomechanical properties were assessed usinga three-point bending device. Musclefrom the same extremitywas obtained to determine relative mRNA expression ofpro-inflammatory cytokines (TNF-α and IL-6) by RT-qPCR.Statistical differences were evaluated by two-way ANOVA and Holm-Sidak method post hoc with P < 0.05. In elderly mice, moderate exercise increased glutathione levels and microarchitecture complexity but decreased bone fragility and oxidative stress markers, cortisol, and pro-inflammatory cytokines. In conclusion, these results suggest a strong link between a pro-inflammatory state and age-conditioned oxidative stress on bone quality. Thus, on a human scale, moderate aerobic exercise may improve bone quality during aging.

PMID:35298960 | DOI:10.1016/j.jbiomech.2022.111035

Water Res. 2022 Mar 8;215:118272. doi: 10.1016/j.watres.2022.118272. Online ahead of print.

ABSTRACT

Water governing systems are twisted with complex interplays among levels and scales which embody their structures. Typically, the mismatch between human-generated and natural systems produces externalities and inefficiencies reflectable in spatial scales. The largely known problem of fit in water governance is investigated to detect the issues of fit between administrative/institutional scales and the hydrological one in a lake basin. To implement the idea, constraining the level of analysis interlinked to the concentrated levels of administration in spatial scales, the fit of the governing system was analyzed by means of statistical mechanics. Modeling the structure of water demand/supply governing system in a given region through the Curie-Weiss Mean Field approximation, the system cost in relation to its structure and fit was appraised and compared with two other conceptual structures in the Urmia Lake Basin in Iran. The methodology articulated an analysis framework for exploring the effectiveness of the formulated water demand/supply governing system and its fit to the relevant hydrological system. The findings of this study may help developing strategies to encourage adaptations, rescaling/reforms for effective watershed management.

PMID:35298993 | DOI:10.1016/j.watres.2022.118272

Res Dev Disabil. 2022 Mar 14;124:104215. doi: 10.1016/j.ridd.2022.104215. Online ahead of print.

ABSTRACT

BACKGROUND: Children with Developmental Language Disorder (DLD) have been found to demonstrate low performance in Executive Functions (EFs). However, the evidence-based data is so far scarce, especially for 4-5-year-old children. Most of the existing research involves English-speaking populations, while very few studies have been carried out with non-English-speaking populations. Nevertheless, it is documented that possible differences in the language-cognition relations may exist due to the specific characteristics of each language, and studies across different languages could contribute to the above.

AIMS: The present study aimed to systematically investigate the profile of oral language and EF skills (verbal and nonverbal) and the way these skills are related with each other in 4-5-year-old Greek-speaking children with and without DLD.

METHODS AND PROCEDURES: Fifty-three 4-5-year-old children (age range: 51- 57 months) with DLD, and 62 Typically Developing (TD) peers (age range: 51- 57 months) were assessed on a standardized psychometric battery for oral language skills (phonological and morphological awareness, oral language comprehension, vocabulary knowledge, narrative speech and pragmatics) and on a series of verbal (v) and nonverbal (nv) tasks tapping EFs skills (updating-accuracy, inhibition -accuracy and reaction time-, and cognitive flexibility).

OUTCOMES AND RESULTS: Children with DLD demonstrated statistically significant lower performance across all oral language measures in comparison to their TD peers. Additionally, they performed significantly lower in the updating (nv) task, as well as in cognitive flexibility (v & nv) in comparison to the TD group. Further regression analyses demonstrated that updating (nv), inhibition (nv) and cognitive flexibility (v) predicted oral language comprehension in children with DLD while updating (v & nv), inhibition-reaction time (nv) and cognitive flexibility (v & nv) predicted phonological and morphological awareness, oral language comprehension, narrative speech as well as total language score in TD children.

CONCLUSIONS AND IMPLICATIONS: These results provide important information about the profile of oral language and EF skills in children with DLD compared to their TD peers as well as on the relationship of these skills in both groups. The findings also suggest that improving EFs skills may be a possible way for improving oral language skills in young children with DLD. Our findings are discussed in terms of their theoretical as well as practical implications regarding the diagnostic and intervention procedures for children with DLD.

PMID:35298958 | DOI:10.1016/j.ridd.2022.104215

Minerva Dent Oral Sci. 2022 Feb;71(1):25-30. doi: 10.23736/S2724-6329.21.04544-7.

ABSTRACT

BACKGROUND: Over the years, numerous studies and advanced technologies about dental implants have been evolved from the traditional two-stage procedure to immediate loading. Implants located in the posterior maxillary region allow to achieve an appropriate prosthetic support. The aim of this work was to solve the atrophied posterior maxilla, through monophasic implants with flapless technique and intraoral electro-welding.

METHODS: In this study were enrolled 120 patients between 20 and 68 years old (mean age of 34.2 years), where females predominate with 53.1% compared to 46.9% males. The patients were presented at the Oral Surgery Clinic of the Aldent University (Tirana, Albania), for a period 2009-2019. Briefly, 310 monophasic implants were placed, TRAMONTE type (Milan, Italy), to the posterior maxilla thus avoiding the sinus, with dense and wide threads, of different lengths and widths. The surgical technique was minimally invasive, flapless one. Data were expressed as mean + standard error (SEM) of all the radiographic outcomes obtained; and as statistical analysis was used the Student’s t-test. P<0.5 and P<0.05, were considered significant.

RESULTS: A part of the patients were hypertensive and type 2 diabetic, then a negligible part were smokers, also a lack of oral hygiene was observed in 40% of cases. After 5 years of observation, it appeared that 95.9% of the implants were successful. Furthermore, the mesial and distal bone loss during the first three years was 0.1 mm, while after 5 years no continuation of bone loss was observed.

CONCLUSIONS: The application of monophasic implants must be performed according to approved protocols, considering the conditions of the posterior maxillary region, obtaining in this way a safe dental implantation.

PMID:35289541 | DOI:10.23736/S2724-6329.21.04544-7

Intern Med J. 2022 Mar 15. doi: 10.1111/imj.15750. Online ahead of print.

ABSTRACT

BACKGROUND: Telehealth was widely adopted in health services during the Covid-19 pandemic. It is unknown what the attitudes and ongoing needs of healthcare staff are after a rapid implementation of telehealth.

AIMS: To evaluate staff attitudes to telehealth utilisation after a rapid implementation.

METHODS: A health service-wide bespoke survey was sent to all clinicians, managers, and administration staff in June-July 2021. We evaluated attitudes to (i) telehealth application in the model of care and (ii) the barriers and enablers to use of telehealth. Descriptive statistics were used for quantitative data, and content analysis for the textual data.

RESULTS: A hundred and thirty-four respondents completed the survey (response rate = 22.5% of healthdirect users (71/315), and = 3.2% of total healthcare staff population). Most commonly, telehealth was identified as being important (78%) and safe (79%) by clinicians; important (100%) and encouraged (88%) by managers. In contrast, telehealth was identified as not the same as face-to-face (56%, 50%); but easy to add to usual work arrangements (43%, 44%) by clinicians and managers, respectively. The most common enablers of telehealth were: (i) having others use the same telehealth platform (74.3%, 100%), and (ii) completing training (68.9%, 72.7%) by clinicians and managers, respectively. The most common barriers were having (i) reliable internet connectivity (39.2%, 45.5%) by clinicians and managers respectively, (ii) the right equipment (clinician 37.8%), and (iii) a private area (managers 36.3%).

CONCLUSIONS: Despite training and having support from colleagues to implement telehealth, ongoing needs were identified that may promote uptake in specific health settings. This article is protected by copyright. All rights reserved.

PMID:35289486 | DOI:10.1111/imj.15750

J Magn Reson Imaging. 2022 Mar 15. doi: 10.1002/jmri.28151. Online ahead of print.

ABSTRACT

BACKGROUND: Magnetic resonance elastography (MRE) is an imaging technique that can noninvasively assess the shear properties of the intervertebral disc (IVD). Unlike the standard gradient recalled echo (GRE) MRE technique, a spin-echo echo-planar imaging (SE-EPI) sequence has the potential to improve imaging efficiency and patient compliance.

PURPOSE: To validate the use of an SE-EPI sequence for MRE of the IVD compared against the standard GRE sequence.

STUDY TYPE: Cross-over.

SUBJECTS: Twenty-eight healthy volunteers (15 males and 13 females, age range: 19-55).

FIELD STRENGTH/SEQUENCE: 3 T; GRE, SE-EPI with breath holds (SE-EPI-BH) and SE-EPI with free breathing (SE-EPI-FB) MRE sequences.

ASSESSMENT: MRE-derived shear stiffnesses were calculated via principal frequency analysis. SE-EPI derived shear stiffness and octahedral shear strain signal-to-noise ratios (OSS-SNR) were compared against those derived using the GRE sequence. The reproducibility and repeatability of SE-EPI stiffness measurements were determined. Shear stiffness was evaluated in the nucleus pulposus (NP) and annulus fibrosus (AF) regions of the disc. Scan times between sequences were compared.

STATISTICAL TESTS: Linear mixed models, Bland-Altman plots, and Lin’s concordance correlation coefficients (CCCs) were used with P < 0.05 considered statistically significant.

RESULTS: Good correlation was observed between shear stiffnesses derived from the SE-EPI sequences with those derived from the GRE sequence with CCC values greater than 0.73 and 0.78 for the NP and AF regions, respectively. OSS-SNR was not significantly different between GRE and SE-EPI sequences (P > 0.05). SE-EPI sequences generated highly reproducible and repeatable stiffness measurements with CCC values greater than 0.97 in the NP and AF regions and reduced scan time by at least 51% compared to GRE. SE-EPI-BH and SE-EPI-FB stiffness measurements were similar with CCC values greater than 0.98 for both regions.

DATA CONCLUSION: SE-EPI-based MRE-derived stiffnesses were highly reproducible and repeatable and correlated with current standard GRE MRE-derived stiffness estimates while reducing scan times.

LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 1.

PMID:35289470 | DOI:10.1002/jmri.28151