Tag: pubmed

JAMA Netw Open. 2022 Feb 1;5(2):e2147351. doi: 10.1001/jamanetworkopen.2021.47351.

ABSTRACT

IMPORTANCE: Gender disparities exist throughout medicine. Recent studies have highlighted an attainment gap between male and female residents in performance evaluations on Accreditation Council for Graduate Medical Education (ACGME) milestones. Because of difficulties in blinding evaluators to gender, it remains unclear whether these observed disparities are because of implicit bias or other causes.

OBJECTIVE: To estimate the magnitude of implicit gender bias in assessments of procedural competency in emergency medicine residents and whether the gender of the evaluator is associated with identified implicit gender bias.

DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study was performed from 2018 to 2020 in which emergency medicine residency faculty assessed procedural competency by evaluating videos of residents performing 3 procedures in a simulated environment. They were blinded to the intent of the study. Proceduralists were filmed performing each procedure from 2 different viewpoints simultaneously by 2 different cameras. One was a gender-blinded (ie, hands-only) view, and the other a wide-angled gender-evident (ie, whole-body) view. The faculty evaluators viewed videos in a random order and assessed procedural competency on a global rating scale with extensive validity evidence for the evaluation of video-recorded procedural performance.

MAIN OUTCOMES AND MEASURES: The primary outcome was to determine if there was a difference in the evaluation of procedural competency based on gender. The secondary outcome was to determine if there was a difference in the evaluations based on the gender of the evaluator.

RESULTS: Fifty-one faculty evaluators enrolled from 19 states, with 22 male participants (43.1%), 29 female participants (56.9%), and a mean (SD) age of 37 (6.4) years. Each evaluator assessed all 60 procedures: 30 gender-blinded (hands-only view) videos and 30 identical gender-evident (wide angle) videos. There were no statistically significant differences in the study evaluators’ scores of the proceduralists based on their gender, and the gender of the evaluator was not associated with the difference in mean scores.

CONCLUSIONS AND RELEVANCE: In this study, we did not identify a difference in the evaluation of procedural competency based upon the gender of the resident proceduralist or the gender of the faculty evaluator.

PMID:35129594 | DOI:10.1001/jamanetworkopen.2021.47351

Rev Esc Enferm USP. 2022 Feb 4;56:e20210474. doi: 10.1590/1980-220X-REEUSP-2021-0474. eCollection 2022.

ABSTRACT

OBJECTIVE: To analyze the effects of an educational intervention in the light of the Meaningful Learning Theory on the knowledge and attitude of Primary Health Care physicians and nurses in the assessment of the degree of physical disability in leprosy.

METHOD: An intervention study of the before-and-after type, conducted with 122 professionals (84 nurses and 38 physicians) from the Primary Health Care of João Pessoa, Paraíba, in a training course on the assessment of the degree of physical disability in leprosy. The data were collected with the research’s own instrument validated and analyzed by the chi-square adherence and proportion test, with a 5% significance level.

RESULTS: There was an increase in the scores of all items of the instrument, with a statistically significant difference (p < 0.05) in 20 of the 32 items, with emphasis on those related to the professional’s technical ability to conduct the stages of anamnesis, palpation of peripheral nerves, sensory and motor evaluation. It is also noteworthy that, after the intervention, 5 items obtained 100% of correct answers.

CONCLUSION: The educational intervention grounded on the Meaningful Learning Theory improved the health professionals’ knowledge and attitude in the assessment of the degree of physical disability in people with leprosy.

PMID:35129573 | DOI:10.1590/1980-220X-REEUSP-2021-0474

JAMA Netw Open. 2022 Feb 1;5(2):e2147363. doi: 10.1001/jamanetworkopen.2021.47363.

ABSTRACT

IMPORTANCE: Infections are proposed to be triggering factors for Kawasaki disease (KD), although its etiological factors remain unknown. Recent reports have indicated a 4- to 6-week lag between SARS-CoV-2 infection and multisystem inflammatory syndrome in children with a similar presentation to that of KD.

OBJECTIVE: To investigate the temporal correlation between KD and viral infections, focusing on respiratory viruses.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted among individuals aged 0 to 19 years diagnosed with KD between January 2010 and September 2020 from the Korean National Health Insurance Service. Data on infectious disease outbreaks from 2016 to 2019 were collected from the Korea Disease Control and Prevention Agency, Korean Influenza and Respiratory Virus Monitoring System, Korea Enteroviruses Surveillance System, and the Enteric Pathogens Active Surveillance Network in South Korea. Data were analyzed from December 2020 to October 2021.

MAIN OUTCOMES AND MEASURES: National databases for infectious diseases were used for a time-series analysis of the correlation between viral infections and KD. The temporal correlation between infectious disease outbreaks and KD outbreaks was evaluated using the Granger causality test (G-test), which is a useful tool to estimate correlations between 2 time series of diseases based on time lags.

RESULTS: Overall, 53 424 individuals with KD were identified, including 22 510 (42.1%) females and 30 914 (57.9%) males and 44 276 individuals (82.9%) younger than 5 years. Intravenous immunoglobulin-resistant KD was identified in 9042 individuals (16.9%), and coronary artery abnormalities were identified in 384 individuals (0.7%). Of 14 infectious diseases included in the analyses, rhinovirus infection outbreaks were identified as significantly correlated at 1 to 3 months before KD outbreaks in South Korea (r = 0.3; 1 month: P < .001; 2 months: P < .001; 3 months: P < .001). Outbreaks of respiratory syncytial virus infection were identified as significantly correlated with KD outbreaks by 2 months (r = 0.5; 2 months: P < .001). Additionally, varicella outbreaks were identified as significantly correlated at 2 and 3 months before KD outbreaks (r = 0.7; 2 months: P < .001; 3 months: P < .001).

CONCLUSIONS AND RELEVANCE: In this cohort study with a time series analysis of children and youth in South Korea with KD, respiratory infections caused by rhinovirus and respiratory syncytial virus and varicella outbreaks were significantly correlated with KD at 1 to 3 months before KD outbreaks.

PMID:35129593 | DOI:10.1001/jamanetworkopen.2021.47363

Ann Surg. 2021 Oct 8. doi: 10.1097/SLA.0000000000005251. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the survival impact of low-titer group O whole blood (LTOWB) in injured pediatric patients who require massive transfusion.

SUMMARY BACKGROUND DATA: Limited data are available regarding the effectiveness of LTOWB in pediatric trauma.

METHODS: A prospective observational study of children requiring massive transfusion after injury at UPMC Children’s Hospital of Pittsburgh, an urban academic pediatric Level 1 trauma center. Injured children ages 1-17 years who received a total of >40 mL/kg of LTOWB and/or conventional components over the 24 hours after admission were included. Patient characteristics, blood product utilization and clinical outcomes were analyzed using Kaplan-Meier survival curves, log rank tests and Cox proportional hazards regression analyses. The primary outcome was 28-day survival.

RESULTS: Of patients analyzed, 27/80 (33%) received LTOWB as part of their hemostatic resuscitation. The LTOWB group was comparable to the component therapy group on baseline demographic and physiologic parameters except: older age, higher body weight and lower red blood cell and plasma transfusion volumes. After adjusting for age, total blood product volume transfused in 24 hours, admission base deficit, international normalized ratio (INR) and injury severity score (ISS), children who received LTOWB as part of their resuscitation had significantly improved survival at both 72 hours and 28 days post-trauma (Adjusted Odds Ratio (AOR) 0.23, p = 0.009 and AOR 0.41, p = 0.02, respectively); 6-hour survival was not statistically significant (AOR = 0.51, p = 0.30). Survivors at 28-days in the LTOWB group had reduced hospital LOS, ICU LOS and ventilator days compared to the CT group.

CONCLUSIONS: Administration of LTOWB during the hemostatic resuscitation of injured children requiring massive transfusion was independently associated with improved 72-hour and 28-day survival.

PMID:35129530 | DOI:10.1097/SLA.0000000000005251

Ann Surg. 2021 Oct 13. doi: 10.1097/SLA.0000000000005254. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine if minimally invasive right colectomy with intracorporeal anastomosis improves postoperative recovery compared to extracorporeal anastomosis.

BACKGROUND: Previous trials have shown that intracorporeal anastomosis improves postoperative recovery; however, it has not yet been evaluated in a setting with optimized perioperative care or with patient-related outcome measures.

METHODS: This was a multicenter, triple-blind, randomized clinical trial at two high-volume colorectal centers with strict adherence to optimized perioperative care pathways. The patients underwent robotic right colectomy with either intracorporeal or extracorporeal anastomosis. The primary outcome was patient-reported postoperative recovery measured using the “Quality of Recovery-15” questionnaire (QoR-15). ClinicalTrials.gov NCT03130166.

RESULTS: A total of 89 patients were randomized and analyzed according to the “Intention-to-treat”-principle. We found no statistically significant differences in patient-reported recovery between the groups. Postoperative pain, nausea, time to ambulation, time to first passage of flatus/stool, length of hospital stay, and pathophysiological tests showed no differences either. The duration of time to create the anastomosis was significantly longer with intracorporeal anastomosis (17 vs. 13 min, P = .003), while all other intraoperative, postoperative, and pathology variables showed no difference.

CONCLUSION: There were no significant differences in postoperative recovery between the two groups.

PMID:35129520 | DOI:10.1097/SLA.0000000000005254

Ann Surg. 2021 Oct 8. doi: 10.1097/SLA.0000000000005240. Online ahead of print.

ABSTRACT

OBJECTIVE: : Economic evaluation of early surgery compared to the endoscopy-first approach in chronic pancreatitis.

SUMMARY BACKGROUND DATA: In patients with painful chronic pancreatitis and a dilated main pancreatic duct, early surgery, as compared with an endoscopy-first approach, leads to more pain reduction with fewer interventions. However, it is unknown if early surgery is more cost-effective than the endoscopy-first approach.

METHODS: The multicenter Dutch ESCAPE trial randomized patients with chronic pancreatitis and a dilated main pancreatic duct between early surgery (surgery within 6 weeks) or the endoscopy-first approach in 30 centers (April 2011 – September 2016). Healthcare utilization was prospectively recorded up to 18 months after randomization. Unit costs of resources were determined, and cost-effectiveness and cost-utility analyses were performed from societal and healthcare perspectives. Primary outcomes were the costs per unit decrease on the Izbicki pain score and per gained quality-adjusted life-year.

RESULTS: In total, 88 patients were included in the analysis, with 44 patients randomized to each group. Total costs were lower in the early surgery group but did not reach statistical significance (mean difference €????4,815 (95 per cent bias-corrected and accelerated confidence interval €????13,113 to €3,411; P=0.25). Early surgery had a probability percentage of 88.4% of being more cost-effective than the endoscopy-first approach at a willingness-to-pay threshold of €0 per day per unit decrease on the Izbicki pain score. The probability percentage per additional gained QALY was 75.7% at a willingness-to-pay threshold of €50,000.

CONCLUSION: In patients with painful chronic pancreatitis and a dilated main pancreatic duct, early surgery was more cost-effective than the endoscopy-first approach.

PMID:35129523 | DOI:10.1097/SLA.0000000000005240

Ann Surg. 2021 Oct 22. doi: 10.1097/SLA.0000000000005261. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to examine associations between the oral, fecal, and mucosal microbiome communities and adenoma formation.

SUMMARY BACKGROUND DATA: Data are limited regarding the relationships between microbiota and preneoplastic colorectal lesions.

METHODS: Individuals undergoing screening colonoscopy were prospectively enrolled and divided into adenoma and nonadenoma formers. Oral, fecal, non-adenoma and adenoma-adjacent mucosa were collected along with clinical and dietary information. 16S rRNA gene libraries were generated using V4 primers. DADA2 processed sequence reads and custom R-scripts quantified microbial diversity. Linear regression identified differential taxonomy and diversity in microbial communities and machine learning identified adenoma former microbial signatures.

RESULTS: One hundred four subjects were included, 46% with adenomas. Mucosal and fecal samples were dominated by Firmicutes and Bacteroidetes whereas Firmicutes and Proteobacteria were most abundant in oral communities. Mucosal communities harbored significant microbial diversity that was not observed in fecal or oral communities. Random forest classifiers predicted adenoma formation using fecal, oral, and mucosal amplicon sequence variant (ASV) abundances. The mucosal classifier reliably diagnosed adenoma formation with an area under the curve (AUC) = 0.993 and an out-of-bag (OOB) error of 3.2%. Mucosal classifier accuracy was strongly influenced by five taxa associated with the family Lachnospiraceae, genera Bacteroides and Marvinbryantia, and Blautia obeum. In contrast, classifiers built using fecal and oral samples manifested high OOB error rates (47.3% and 51.1%, respectively) and poor diagnostic abilities (fecal and oral AUC = 0.53).

CONCLUSION: Normal mucosa microbial abundances of adenoma formers manifest unique patterns of microbial diversity that may be predictive of adenoma formation.

PMID:35129506 | DOI:10.1097/SLA.0000000000005261

Subst Abus. 2022;43(1):801-808. doi: 10.1080/08897077.2021.2010255.

ABSTRACT

Background: Two Way Prayer Meditation (TWPM) is a spiritual intervention that holds promise for improving the psychospiritual well-being of individuals in recovery from substance use disorders (SUD). This study aimed to identify moderators of TWPM’s treatment effects. Moderators tested included gender, race/ethnicity, age, education, religious/spiritual affiliation, and most often used substance. Methods: This study employed a randomized controlled trial design with pretest and posttest. In total, 134 adults in four residential recovery programs participated in the study and were randomly assigned to the TWPM group or the treatment as usual control group. Linear mixed modeling was used to assess the moderating effect of each hypothesized moderator in the form of interaction tests. Sensitivity analyses were conducted by excluding cases with more than a minimum number of missing items. Results: There were no significant moderators for psychological distress, self-esteem, and most of the spiritual well-being outcomes. Both the primary and sensitivity analyses showed education significantly moderated TWPM’s effect on overall spirituality self-ranking. Specifically, TWPM’s positive effect on overall spirituality self-ranking was greater in the master’s degree subgroup than in the less than high school subgroup. Conclusion: TWPM’s treatment effects on most outcomes were not found to vary by the tested participant characteristics. The only statistically significant finding suggests clinicians may need to adjust TWPM workshop/teaching content, delivery style, or language used to reach clients with lower levels of education. Future better-powered studies are recommended to continue exploring the potential moderating effects of race/ethnicity, education, spiritual/religious affiliation, and most often used substance.

PMID:35129421 | DOI:10.1080/08897077.2021.2010255

Ann Surg. 2021 Nov 11. doi: 10.1097/SLA.0000000000005296. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the long-term and short-term outcomes of minimally invasive esophagectomy (MIE) compared with open esophagectomy (OE) in localized esophageal squamous cell carcinoma (ESCC) patients in real-world settings.

BACKGROUND: MIE is an alternative to OE, despite the limited evidence regarding its effect on long-term survival.

METHODS: We recruited 5822 consecutive patients with resectable ESCC in two typical high-volume centers in southern and northern China, 1453 of whom underwent MIE. Propensity score-based overlap weighted regression adjusted for multifaceted confounding factors was used to compare outcomes in the MIE and OE groups.

RESULTS: Five-year overall survival (OS) was 62.7% in the MIE group and 57.7% in the OE group. The overlap weighted Cox regression showed slightly better OS in the MIE group (HR 0.93, 95% CI: 0.82-1.06). Although duration of surgery was longer and treatment cost higher in the MIE group than in the OE group, the number of lymph nodes harvested was larger, the proportion of intraoperative blood transfusions lower, and postoperative complications less in the MIE group. 30-day (RR 0.77, 0.38-1.55) and 90-day (RR 0.79, 0.46-1.35) mortality were lower in the MIE group versus the OE group, although not statistically significant. These findings were consistent across different analytic approaches and subgroups, notably in the subset of ESCC patients with large tumors.

CONCLUSIONS: MIE can be performed safely with OS comparable to OE for patients with localized ESCC, indicating MIE may be recommended as the primary surgical approach for resectable ESCC in health facilities with requisite technical capacity.

PMID:35129490 | DOI:10.1097/SLA.0000000000005296

Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi. 2021 Dec 21;33(6):626-628. doi: 10.16250/j.32.1374.2021044.

ABSTRACT

OBJECTIVE: To investigate the epidemiological characteristics and diagnosis of malaria cases in Nantong City from 2015 to 2020, so as to provide insights into the prevention of re-establishment of imported malaria and consolidation of malaria elimination achievements in the city.

METHODS: The epidemic data of malaria in Nantong City from 2015 to 2020 were captured from the National Notifiable Disease Report System, the Information Management System for Parasitic Disease Control and individual epidemiological survey reports of malaria cases. The malaria parasite species, source of infections, population distribution, temporal distribution, spatial distribution and diagnosis of imported malaria cases were descriptively and statistically analyzed.

RESULTS: A total of 241 malaria cases were reported in Nantong City from 2015 to 2020, and all were overseas imported cases, including 191 cases with Plasmodium falciparum malaria (79.25%), 8 cases with P. vivax malaria (3.32%), 33 cases with P. ovale malaria (13.69%) and 9 cases with P. malaria malaria (3.73%). Overseas imported malaria cases acquired infections from 34 countries in Asia, Africa and Latin America, and 97.93% of the cases were infected in Africa, and 90.04% (217/241) were reported in Chongchuan District, Hai’an City and Haimen District. Imported malaria cases were aged from 20 to 68 years, and a median age of 45 (13) years, and 97.10% were male. The median duration between returning to China and malaria onset was 7 (9) days among all imported malaria cases, and the median duration from initial diagnosis to definitive diagnosis was 2 (2) days. There were 167 cases that were initially diagnosed as malaria, with a correct rate of 69.29%, and 53.53 (129/241) of malaria cases were diagnosed at city-level medical institutions and 41.49% (100/241) at county-level medical institutions. In addition, the proportion of malaria cases reported by city-level medical institutions increased from 39.62% in 2015 to 81.25% in 2020 (χ² = 6.94, P < 0.01).

CONCLUSIONS: The accuracy of initial malaria diagnosis requires to be improved in Nantong City. Malaria control knowledge should be specially given to migrant workers to shorten the duration of seeking medical care, and malaria training requires to be intensified among healthcare professionals to improve the diagnostic capability of imported malaria cases and the cure of severe P. falciparum malaria cases.

PMID:35128894 | DOI:10.16250/j.32.1374.2021044