Tag: pubmed

BJU Int. 2021 Jun 16. doi: 10.1111/bju.15516. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate volume-outcome relationships in robot-assisted radical prostatectomy for cancer using data from the Hospital Episodes Statistics (HES) database for England.

MATERIALS AND METHODS: Data for all adult, elective radical prostatectomies for cancer during the period January 2013-December 2018 (inclusive) were extracted from the HES database. HES records data on all National Health Service hospital admissions in England. Data were extracted for the NHS trust and surgeon undertaking the procedure, the surgical technique used (laparoscopic, open or robot-assisted), length of hospital stay, emergency readmissions and deaths. Multilevel modelling was used to adjust for hierarchy and covariates.

RESULTS: Data were available for 35,629 radical prostatectomies (27,945 robot-assisted). The proportion of procedures conducted as robot-assisted surgery increased from 53.2% in 2013 to 92.6% in 2018. For robot-assisted surgery, there was a significant relationship between 90-day emergency hospital readmission (primary outcome) and trust volume (odds ratio for volume decrease of ten procedures 0.99 (95% confidence interval 0.99 to 1.00, p = 0.037) and surgeon volume (odds ratio for volume decrease of ten procedures 0.99 (95% confidence interval 0.99 to 1.00, p = 0.013) in the previous year. From lowest to highest volume category there was a decline in the adjusted proportion of patients readmitted as an emergency at 90 days from 10.6% (0-49 procedures) to 7.0% (≥ 300 procedures) for trusts and from 9.4% (0-9 procedures) to 8.3% (≥ 100 procedures) for surgeons. Length of stay was also significantly associated with surgeon and trust volume, although one year mortality was associated with neither.

CONCLUSIONS: There is evidence of a volume-outcome relationship for robot-assisted radical prostatectomy in England and minimising low volume surgery will improve patient outcomes. Nevertheless, the observed effect size was relatively modest, and stakeholders should be realistic when evaluating the likely impact of further centralisation at a population level.

PMID:34133832 | DOI:10.1111/bju.15516

Int J Paediatr Dent. 2021 Jun 16. doi: 10.1111/ipd.12851. Online ahead of print.

ABSTRACT

BACKGROUND: Implementing effective pain management is important to increase patient compliance in pediatric dental procedures.

AIM: This pilot study was conducted to evaluate the effectiveness of virtual reality (VR) on pain perception in dental procedures in children.

MATERIAL AND METHODS: 54 children aged between 5-12 years were included. Patients scheduled to receive dental procedures not requiring local anesthesia (e.g., fluoride therapy) were assigned to Group A, and patients scheduled to receive painful dental procedures requiring local anesthesia (e.g., pulp therapies, teeth extraction) were assigned to Group B. Patients in each group were randomly assigned and were equally likely to either receive VR during their dental procedure, or treatment as usual (without VR). Visual Analog Scale (VAS), Wong-Baker faces rating scale, and the ‘Face, Legs, Activity, Cry, Consolability’ scale (FLACC scale) were used to assess the pain levels during dental procedures.

RESULTS: Patients receiving painful dental procedures requiring local anesthesia reported significant reductions in pain intensity/worst pain during the dental procedure on all subjective and behavioral pain measures of pain intensity, (p<0.05 on each). Patients receiving non-painful dental procedures showed the predicted pattern but no significant reduction in worst pain during VR.

CONCLUSION: The use of VR was found to be an effective distraction tool to ease pain and anxiety in the tested dental procedures, for children receiving painful dental procedures.

PMID:34133809 | DOI:10.1111/ipd.12851

Acad Emerg Med. 2021 Jun 16. doi: 10.1111/acem.14312. Online ahead of print.

ABSTRACT

OBJECTIVES: To conduct an umbrella review of therapeutic studies relevant to emergency medicine, analyzing patterns in effect size, power and signals of potential bias across an entire field of clinical research.

METHODS: We combined topic and journal-driven searches of PUBMED and Google Scholar for published articles of systematic reviews and meta-analyses relevant to emergency medicine (last search in November 2020). Data were screened and extracted by 6 investigators. Redundant meta-analyses were removed. Whenever possible for each comparison we extracted one meta-analysis on mortality with the most events, and one meta-analysis on a non-mortality outcome with the most studies. From each meta-analysis we extracted all individual study effects; outcomes were converted to odds ratios and placed on a common scale where an odds ratio <1.0 represents a reduction in a harmful outcome with an experimental treatment versus control. Outcomes were analyzed at the level of individual studies and at the level of summary effects across meta-analyses.

RESULTS: 332 articles contained 431 eligible meta-analyses with a total of 3129 individual study outcomes; of these, 2593 (83%) were from randomized controlled trials. The median odds ratio across all studies was 0.70. Within each meta-analysis, the earliest study effect on average demonstrated larger benefit compared to the overall summary effect. Only 57 of 431 meta-analyses (13%) both favored the experimental intervention and did not show any signal of small study effects or excess significance, and of those only 12 had at least one study with 80% or higher power to detect an odds ratio of 0.70. Of these, no interventions significantly decreased mortality in well-powered trials. Although the power of studies increased somewhat over time, the majority of studies were underpowered.

CONCLUSIONS: Few interventions studied within systematic reviews and meta-analyses relevant to emergency medicine seem to have strong and unbiased evidence for improving outcomes. The field would benefit from more optimally powered trials.

PMID:34133813 | DOI:10.1111/acem.14312

Int J Cosmet Sci. 2021 Jun 16. doi: 10.1111/ics.12720. Online ahead of print.

ABSTRACT

INTRODUCTION: Evaluation of skin ageing is a non-standardised, subjective process, with typical measures relying coarse, qualitatively defined features. Reflectance confocal microscopy depth stacks contain indicators of both chrono- and photo-ageing. We hypothesise that an ageing scale could be constructed using machine learning and image analysis, creating a data driven quantification of skin ageing without human assessment.

METHODS: En-face sections of reflectance confocal microscopy depth stacks from the dorsal and volar forearm of 74 participants (36/18/20 training/testing/validation) were represented using a histogram of visual features learned using unsupervised clustering of small image patches. A logistic regression classifier was trained on these histograms to differentiate between stacks from 20-30 year old and 50-70 year old volunteers. The probabilistic output of the logistic regression was used as the fine grained ageing score for that stack in the testing set ranging from 0 to 1. Evaluation was performed in two ways: on the test set the AUC was collected for the binary classification problem as well as by statistical comparison of the scores for age and body-site groups. Final validation was performed by assessing the accuracy of the ageing score measurement on 20 depth stacks not used for training or evaluating the classifier.

RESULTS: The classifier effectively differentiated stacks from age groups with an test set AUC of 0.908. Mean scores were significantly different when comparing age groups (mean 0.70 vs. 0.44; t=-6.62, p=0.0000) and also when comparing stacks from dorsal and volar body sites (mean 0.64 vs. 0.53; t=3.12, p=0.0062). On the final validation set 17 out of 20 depth stacks were correctly labelled.

DISCUSSION: Despite being limited to only coarse training information in the form of example stacks from two age groups, the trained classifier was still able to effectively discriminate between younger and older skin. Curiously, despite being only trained with chronological age, there was still evidence for measurable differences in age scores due to sun exposure – with marked differences in scores on sun exposed dorsal sites of some volunteers compared to less sun exposed volar sites. These results suggest that fine-grained data driven quantification of skin ageing is achievable.

PMID:34133771 | DOI:10.1111/ics.12720

Acta Paediatr. 2021 Jun 16. doi: 10.1111/apa.15987. Online ahead of print.

ABSTRACT

AIM: Our aim was to evaluate upper GI pathology found endoscopically among children seen in a GI feeding clinic for persistent feeding problems compared with controls.

METHODS: Esophagogastroduodenoscopy biopsy results were examined among two cohorts of children. The first group included 86 children evaluated in a gastroenterology feeding clinic for pediatric feeding disorders. A comparison was made with an age-matched control group of 86 children referred for endoscopy for conditions other than disordered feeding.

RESULTS: In the feeding cohort, 57% had abnormal endoscopy biopsies. These included 30% with microscopic esophagitis and 15.1 % with eosinophilic esophagitis. Among the controls, 53% had abnormal biopsies, which included 26% with microscopic esophagitis and 8% with eosinophilic esophagitis. The statistical comparison between groups included p = 0.98 for microscopic esophagitis and p = 0.15 for eosinophilic esophagitis.

CONCLUSION: Results demonstrated similar prevalence of abnormal endoscopy biopsies and microscopic esophagitis in both groups. The incidence of eosinophilic esophagitis in the feeding group triples that of previous reports and nearly doubles controls. Our findings suggest pediatric feeding disorders which do not resolve, may warrant investigation by upper endoscopy.

PMID:34133806 | DOI:10.1111/apa.15987

Rev Bras Enferm. 2021 Jun 9;74(3):e20200732. doi: 10.1590/0034-7167-2020-0732. eCollection 2021.

ABSTRACT

OBJECTIVES: To analyze the abstracts that relate nursing to the Theory of Culture Care Diversity and Universality, published in the annals of the main national scientific events in the category, over a 12-year period.

METHODS: documental research carried out in the annals of the Brazilian Nursing Congress and the National Nursing Research Seminar. Data collection took place from July/2018 to June/2019 using a form. Data was analyzed using descriptive statistics and content analysis.

RESULTS: 99 studies were analyzed, and three categories emerged: Cultural diversity, emic perspective, and cultural context: possibilities for applying the theory; Incongruencies and peculiarities of the care sectors: limitations of the application of the theory; Knowledge production to improve care: implications for professional nursing practice.

FINAL CONSIDERATIONS: the investigated scientific production enabled the construction of knowledge of cultural aspects related to nursing care and showed similarities and variations in care practices.

PMID:34133681 | DOI:10.1590/0034-7167-2020-0732

Rev Assoc Med Bras (1992). 2021 Jun 9:S0104-42302021005002206. doi: 10.1590/1806-9282.67.01.20200487. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to demonstrate the clinical utility of CHA2DS2-VASc and anticoagulation and risk factors in atrial fibrillation risk scores in the assessment of one year mortality in patients with abdominal aortic aneurysm.

METHODS: We designed a retrospective cohort study using data from Suleyman Demirel University Hospital for the diagnosis of abdominal aortic aneurysm. The study included 120 patients with abdominal aortic aneurysm who underwent aortic computed tomography. Patients were divided into two groups according to presence of abdominal aortic aneurysm and the development of mortality. Predictors of mortality were determined by multiple logistic regression analysis.

RESULTS: Multivariate regression analysis showed that CHA2DS2-VASc score, advanced age, female gender and elevated white blood cell counts were independent predictors of abdominal aortic aneurysm development while CHA2DS2-VASc score and elevated glucose levels were independent predictors of one year mortality in patients with abdominal aortic aneurysm. The concordance statistics for anticoagulation and risk factors in atrial fibrillation risk Score and CHA2DS2-VASc risk score respectively were 0.96 and 0.97 and could significantly predict one year mortality in patients with abdominal aortic aneurysm (p<0.001, and p<0.001, respectively).

CONCLUSIONS: CHA2DS2-VASc and anticoagulation and risk factors in atrial fibrillation risk scores are easily obtained in an emergency setting and can accurately predict one year mortality as a noninvasive follow-up in patients with abdominal aortic aneurysm. These simple scores could be used as a point of care decision aid to help the clinician in counseling patients presenting with abdominal aortic aneurysm and their families on treatment protocols.

PMID:34133696 | DOI:10.1590/1806-9282.67.01.20200487

Rev Bras Enferm. 2021 Jun 11;74(suppl 4):e20200138. doi: 10.1590/0034-7167-2020-0138. eCollection 2021.

ABSTRACT

OBJECTIVE: to analyze the association of skin-to-skin contact and social determinants of health.

METHODS: this is a cross-sectional study with 187 medical records of newborns from a reference rooming in in northeastern Brazil. An instrument with maternal and neonatal data was used. Analysis was descriptive and inferential statistics. For the associations, a chi-square test was used to measure strength, an Odds Ratio was calculated, with a 95% confidence interval.

RESULTS: 62% of newborns who made skin-to-skin contact at birth were eutrophic, full-term, Apgar > 7, mothers with prenatal care and without abortion. The determinants associated with non-skin-to-skin contact were preterm (CR=3.2;95%CI: 2.72-18.98); 1st minute Apgar < 7 (CR:2.9;95%CI: 2.38-3.06), cesarean section (CR:8.4;95%CI: 4.29-16.57), and unhealthy NB (CR 12.7;95%CI: 4.9-32.67). We used STROBE guidelines.

CONCLUSION: skin-to-skin contact was influenced by gestational age, Apgar, delivery, and newborn health.

PMID:34133704 | DOI:10.1590/0034-7167-2020-0138

Rev Bras Enferm. 2021 Jun 14;74(6):e20200725. doi: 10.1590/0034-7167-2020-0725. eCollection 2021.

ABSTRACT

OBJECTIVE: Identify the knowledge of family members of children and adolescents with cancer about their legal rights, difficulties, and concessions to ensure them.

METHOD: Quantitative study, survey type, of intersectional design. A questionnaire drawn up by the researchers was applied in order to characterize the minor and their family and also to identify the family’s knowledge about legal rights. Descriptive statistics were used to analyze data.

RESULTS: 61 family members who participated know some more rights to the detriment of others and are especially motivated to search for information when negative impacts on the financial life increase, with repercussions beyond family health.

CONCLUSION: the studied population requires more information and demands knowledge about some rights guaranteed by law. Guidance on rights empowers the family and guarantees the necessary care, searching to have an intersectoral action qualify care and assist in restructuring family dynamics to deal with chronic conditions.

PMID:34133671 | DOI:10.1590/0034-7167-2020-0725

Rev Bras Enferm. 2021 Jun 11;74(2):e20190803. doi: 10.1590/0034-7167-2019-0803. eCollection 2021.

ABSTRACT

OBJECTIVES: to assess the risks of pathogenic suffering related to the experience of nursing workers in the operating room of a university hospital.

METHODS: cross-sectional, quantitative study, carried out from 11/2017 to 01/2018 in a university hospital in the South of Brazil. The sample was composed by 159 nursing workers of the units of a surgical center, that answered to the Scale of Evaluation of Pathogenic Suffering at Work. Data was submitted to statistical analysis.

RESULTS: the workers present low risk of pathogenic suffering related to the experiences at work, being the results of its factors: Uselessness (1.47±0.761) – low risk; Indignity (2.372±1.035) – medium risk; and Disqualification (1.74±0.903) – low risk.

CONCLUSIONS: the evaluation of Pathogenic Suffering at Work Scale was positive, predominating low risk for pathogenic suffering of surgical center workers related to professional experiences, because they feel useful, valued and are not indignant about their work, feelings that reflect on the quality of care provided.

PMID:34133672 | DOI:10.1590/0034-7167-2019-0803