Tag: pubmed

Am J Clin Nutr. 2021 Mar 1:nqaa401. doi: 10.1093/ajcn/nqaa401. Online ahead of print.

ABSTRACT

BACKGROUND: The Omega-3 Index (OI) is a proposed marker of coronary artery disease (CAD) risk. Another index, the EPA/arachidonic acid (AA) ratio has also been proposed as a possible risk marker for CAD.

OBJECTIVE: Our primary objective was to characterize the Canadian population subgroups that have an undesirable OI (<4%, associated with high CAD risk) and to identify the participants’ characteristics most strongly associated with the OI. Our secondary objective was to identify the characteristics most strongly associated with the EPA/AA ratio.

DESIGN: Data from 4025 adult participants of cycles 3 and 4 (2012-2015) of the cross-sectional Canadian Health Measures Survey were pooled. Adjusted mean proportions of erythrocyte membrane ω-3 (n-3) fatty acids, total ω-6 fatty acids, and ratios were analyzed by sociodemographic, health, and lifestyle characteristics using covariate-adjusted models.

RESULTS: The mean OI was 4.5%. Almost 40% of Canadians had an undesirable (<4%) OI. ω-3 supplement use, fish intake, and race were the variables most strongly associated with OI scores. The prevalence of undesirable OI was significantly higher among participants consuming fish less than twice a week (43.8%; 95% CI: 39.0%, 48.6%) than among those consuming more fish (12.7%; 95% CI: 7.8%, 19.9%), among smokers (62.7%; 95% CI: 52.9%, 71.7%) than nonsmokers (33.4%; 95% CI: 29.4%, 37.7%), in whites (42.7%; 95% CI: 38.2%, 47.4%) than in Asians (23.0%; 95% CI: 15.4%, 33.0%), and in adults aged 20-39 y (49.6%; 95% CI: 42.3%, 56.9%) than in those aged 60-79 y (24.4%; 95% CI: 21.0%, 28.1%). ω-3 supplement intake and fish intake were the characteristics most strongly associated with EPA/AA. All P ≤ 0.05.

CONCLUSIONS: An important proportion of Canadian adults has an undesirable (<4%) OI, with higher prevalence in some subgroups. Further assessment is required to determine the value and feasibility of an increase in the population’s OI to the currently proposed target of ≥8% as a potential public health objective.

PMID:33675340 | DOI:10.1093/ajcn/nqaa401

J Infect Dis. 2021 Mar 2:jiab120. doi: 10.1093/infdis/jiab120. Online ahead of print.

ABSTRACT

It is currently unknown how Post-COVID-19 Syndrome (PCS) may affect those infected with SARS-CoV-2. This longitudinal study reports on healthcare staff who tested positive for SARS-CoV-2 between March-April 2020 and follows their antibody titres and symptomatology. Over half (n=21/38) had PCS at 7-8 months. There was no statistically significant difference between initial RT-PCR viral titres or serial antibody levels between those who did and did not develop PCS. This study highlights the relative commonality of PCS in healthcare workers and this should be considered in vaccination scheduling and workforce planning to allow adequate frontline staffing numbers.

PMID:33675366 | DOI:10.1093/infdis/jiab120

Comput Inform Nurs. 2021 Mar 5. doi: 10.1097/CIN.0000000000000692. Online ahead of print.

ABSTRACT

The objective of this study was to identify nurses’ workarounds related to the use of electronic medical records in a tertiary teaching hospital. A total of 106 nurses (84.8%) using the electronic medical records completed 10-item questionnaires scored on a Likert scale and five open-ended questions with written responses. The numerical data were analyzed by descriptive statistics, and the written descriptions were categorized by meaning. The mean of the scored items ranged from 3.29 to 3.74. Approximately 38% to 50% of the participants reported (very) frequent workflow delays due to the use of the electronic medical records, and 46% to 64% reported (very) frequently using workarounds. Twenty-nine workarounds of the electronic medical records were due to electronic documentation, difficulty accessing the electronic medical records, medication administration, covering physician responsibilities, electronic communication with the physicians, respondents and physicians not skilled in using the electronic medical records, and connection failures between devices or machines and the electronic medical records. Although none of these identified workarounds were intended to be harmful, and certain workarounds were efficient for patient care and workflow, whether patient safety can be jeopardized by workarounds should be considered. This study contributes to the understanding of why and how workarounds occur in the hospital. It will be useful for achieving greater alignment between work contexts and the electronic medical record in the future.

PMID:33675300 | DOI:10.1097/CIN.0000000000000692

Ther Drug Monit. 2021 Mar 2. doi: 10.1097/FTD.0000000000000862. Online ahead of print.

ABSTRACT

BACKGROUND: Personalizing busulfan doses to target a narrow plasma exposure has improved the efficacy and lowered the toxicity of busulfan-based conditioning regimens used in hematopoietic cell transplant (HCT). Regional regulations guide interlaboratory proficiency testing for busulfan concentration quantification and monitoring. To date, there have been no comparisons of the busulfan pharmacokinetic modeling and dose recommendation protocols used in these laboratories. Here, in collaboration with the Dutch Association for Quality Assessment in Therapeutic Drug Monitoring and Clinical Toxicology, a novel interlaboratory proficiency program for the quantitation, pharmacokinetic modeling, and dosing of busulfan in plasma was designed. The methods and results of the first two rounds of this proficiency testing are described herein.

METHODS: A novel method was developed to stabilize busulfan in N,N-dimethylacetamide, which allowed shipping of the proficiency samples without dry ice. In each round, participating laboratories reported their results for two proficiency samples (one low and one high busulfan concentrations) and a theoretical case assessing their pharmacokinetic modeling and dose recommendations. All participants were blinded to the answers; descriptive statistics were used to evaluate their overall performance. The guidelines suggested that answers within ±15% for busulfan concentrations and ±10% for busulfan plasma exposure and dose recommendation were to be considered accurate.

RESULTS: Of the four proficiency samples evaluated, between 67% and 85% of the busulfan quantitation results were accurate (i.e., within 85-115% of the reference value). The majority (88% round #1; 71% round #2) of the dose recommendation answers were correct.

CONCLUSION: A proficiency testing program by which laboratories are alerted to inaccuracies in their quantitation, pharmacokinetic modeling, and dose recommendations for busulfan in HCT recipients was developed. This round of proficiency testing suggests that additional educational efforts and proficiency rounds are needed to ensure appropriate busulfan dosing.

PMID:33675302 | DOI:10.1097/FTD.0000000000000862

Retina. 2021 Mar 3. doi: 10.1097/IAE.0000000000003164. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the association between female reproductive factors and the incidence of exudative age-related macular degeneration (AMD).

METHODS: A total of 1,297,388 postmenopausal women over 50 years of age who participated in both national health screening and cancer screening in 2009 were identified using the Korea National Health Insurance System database. Data on female reproductive factors were collected using a self-administered questionnaire. Patients were followed up until 2018, and the incident cases of exudative AMD were identified. The hazard ratios and 95% confidence intervals for exudative AMD were estimated using the multivariable-adjusted Cox proportional hazard model.

RESULTS: During a mean follow-up of 7.27 years, 4,086 patients were newly diagnosed with exudative AMD. The hazard ratio (95% confidence intervals) for exudative AMD was 1.14 (1.01-1.31) for a reproductive period ≥ 40 years compared to a reproductive period < 30 years, and 1.72 (1.48-2.00) for patients with ≥ 5 years of hormone replacement therapy (HRT), and 1.29 (1.09-1.52) for those with 2-5 years of HRT compared to those who never underwent HRT.

CONCLUSION: Female reproductive factors were associated with the risk of exudative AMD. Greater lifetime exposure to endogenous and exogenous estrogen was associated with a higher incidence of exudative AMD.

PMID:33675332 | DOI:10.1097/IAE.0000000000003164

J Adv Nurs. 2021 Mar 6. doi: 10.1111/jan.14813. Online ahead of print.

ABSTRACT

AIM: To evaluate the impact of a psychoeducational, mobile health intervention based on cognitive behavioural therapy and mindfulness-based approaches on the mental health of healthcare workers at the frontline against COVID-19 in Spain.

DESIGN: We will carry out a two-week, individually randomized, parallel group, controlled trial. Participants will be individually randomized to receive the PsyCovidApp intervention or control App intervention.

METHODS: The PsyCovidApp intervention will include five modules: emotional skills, lifestyle behaviour, work stress and burnout, social support, and practical tools. Healthcare workers having attended patients with COVID-19 will be randomized to receive the PsyCovidApp intervention (intervention group) or a control App intervention (control group). A total of 440 healthcare workers will be necessary to assure statistical power. Measures will be collected telephonically by a team of psychologists at baseline and immediately after the 2 weeks intervention period. Measures will include stress, depression and anxiety (DASS-21 questionnaire-primary endpoint), insomnia (ISI), burnout (MBI-HSS), post-traumatic stress disorder (DTS), and self-efficacy (GSE). The study was funded in May 2020, and was ethically approved in June 2020. Trial participants, outcome assessors and data analysts will be blinded to group allocation.

DISCUSSION: Despite the increasing use of mobile health interventions to deliver mental health care, this area of research is still on its infancy. This study will help increase the scientific evidence about the effectiveness of this type of intervention on this specific population and context.

IMPACT: Despite the lack of solid evidence about their effectiveness, mobile-based health interventions are already being widely implemented because of their low cost and high scalability. The findings from this study will help health services and organizations to make informed decisions in relation to the development and implementation of this type of interventions, allowing them pondering not only their attractive implementability features, but also empirical data about its benefits.

CLINICAL TRIAL REGISTRATION: NCT04393818 (ClinicalTrials.gov identifier).

APPROVED FUNDING: May 2020.

PMID:33675247 | DOI:10.1111/jan.14813

Pharmacoepidemiol Drug Saf. 2021 Mar 6. doi: 10.1002/pds.5220. Online ahead of print.

ABSTRACT

PURPOSE: Current guidelines have no sex-specific dosage advice for metoprolol. To evaluate whether women and men are prescribed the same dose a cohort analysis was performed in the population-based Rotterdam Study (RS). Results were replicated in the Integrated Primary Care Information (IPCI) database of automated general practice data.

METHODS: The mean daily starting doses of metoprolol in both sexes were compared with independent-samples t-tests and a linear regression analysis was used to adjust in the Rotterdam Study for co-variables, notably, cardiovascular comorbidity, migraine, age, SBP, DBP, BMI, socioeconomic status, use of other antihypertensive drugs, smoking, and alcohol. In the IPCI-database, adjustment was for age only.

RESULTS: The mean daily starting dose was statistically significantly lower in women than in men in both the RS and IPCI database, with a mean difference of 4.8 mg (95%CI -7.8,-1.8) and 4.6 mg (95%CI -5.3,-4.0), respectively. Statistical significance remained after adjustment in both databases.

CONCLUSIONS: Women received lower starting doses of metoprolol than men in two independent data collections despite non-sex specific cardiovascular guideline recommendations. This example of real-life pharmacotherapy can lead to a form of confounding by contraindication in pharmacoepidemiology.

PMID:33675258 | DOI:10.1002/pds.5220

J Med Radiat Sci. 2021 Mar 6. doi: 10.1002/jmrs.464. Online ahead of print.

ABSTRACT

INTRODUCTION: Most primary ocular adnexal lymphomas are those involving mucosa-associated lymphoid tissue (MALT). Radiotherapy (RT) dose regimens in the literature vary from the historically used high doses (up to 56 Gy) to lower dose RT. We aimed to examine our institution’s experience with the use of orbital RT for treating early-stage primary ocular adnexal MALT lymphoma (POAML).

METHODS: Patients treated for stage I or II POAML over a 12-year period (July 2006 to June 2018) were identified through institutional databases. Data were retrospectively collated through review of patient records. Descriptive statistical methods were employed to analyse the data.

RESULTS: Eighteen patients (median age of 67; range 44-87yrs) with localised POAML (3 cases of bilateral disease) were identified, resulting in a total of 21 evaluable orbits. Eight (44%) patients were female, and all were documented to be of good performance status (ECOG 0-1). The median follow-up was 34 months (range 8-75 months). The commonest dose fractionation used was 20 Gy in 10 fractions (n = 13 orbits) and a 3D conformal or volumetric modulated arc therapy (VMAT) technique was used in the majority of cases. None of the patients experienced an in-field recurrence. One patient had experienced a contralateral orbital recurrence two years post-unilateral orbital RT for orbital MALT lymphoma. Three patients experienced distant relapse.

CONCLUSION: The use of lower dose orbital RT such as 20 Gy in 10 fractions (or radio biologically equivalent) yields excellent local disease control in the management of ocular adnexal MALT lymphoma. The durability of the response appears to be favourable. Given the indolent nature of the disease and the low levels of toxicity associated with lower dose orbital RT, this regimen remains our favoured approach to the management of localised POAML.

PMID:33675287 | DOI:10.1002/jmrs.464

Diagnosis (Berl). 2021 Mar 5. doi: 10.1515/dx-2020-0139. Online ahead of print.

ABSTRACT

OBJECTIVES: Diagnostic Management Teams (DMTs) are one strategy for reducing diagnostic errors. This study examined errors in serology test selection after a positive antinuclear antibody (ANA) test in patients with suspected systemic autoimmune rheumatic disorder (SARD).

METHODS: This retrospective study included 246 patient cases reviewed by our ANA DMT from March to August 2019. The DMT evaluated the appropriateness of tests beyond ANA screening tests (overutilization, underutilization, or both) based on American College of Rheumatology recommendations and classified cases into diagnostic error or no error groups. Errors were quantified, and patient and provider characteristics associated with diagnostic errors were assessed.

RESULTS: Among 246 cases, 60.6% had at least one diagnostic error in test selection. The number of sub-serology tests ordered was 2.4 times higher in the diagnostic error group than in the no error group. The likelihood of at least one diagnostic error was higher in males and African American/Black patients, although the differences were not statistically significant. Providers from general internal medicine, primary care, and non-rheumatology specialties were approximately two times more likely to make diagnostic errors than rheumatology specialists.

CONCLUSIONS: Diagnostic errors in test selection after a positive ANA for patients with suspected SARD were common, although there were fewer errors when ordered by rheumatology specialists. These findings support the need to develop strategies to reduce diagnostic errors in test selection for autoimmunity evaluation and suggest that implementation of a DMT can be useful for providing guidance to clinicians to reduce overutilization and underutilization of laboratory tests.

PMID:33675217 | DOI:10.1515/dx-2020-0139

Orthop Surg. 2021 Mar 5. doi: 10.1111/os.12946. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the clinical and radiographic outcomes between the Tri-Lock Bone Preservation Stem (BPS) and the conventional standard Corail stem in primary total hip arthroplasty (THA).

METHODS: From March 2012 to May 2014, we retrospectively reviewed 84 patients (104 hips) who received Tri-Lock (BPS) and 84 patients (115 hips) who received conventional standard Corail stem in THA. Their mean ages were 53.12 ± 2.32 years and 52.00 ± 2.11 years, respectively. The clinical outcomes were assessed by Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Pain Visual Analogue Scale (VAS) and Harris Hip Score (HHS). The radiological outcomes were evaluated by the radiological examination. Accordingly, Intraoperative and postoperative complications were observed as well.

RESULTS: The mean follow-up time was 48.23 ± 2.91 months in the Tri-Lock (BPS) group and 49.11 ± 2.11 months in the Corail group, respectively. The bleeding volumes in two groups were comparable (169.22 ± 58.11 mL vs 179.30 ± 59.14 mL, P = 0.003), with more bleeding volume in Corail group patients, while no statistically significance with respect to operation time was observed (65.41 ± 6.24 min vs 63.99 ± 6.33 min, P = 0.567). The rates of intraoperative fracture was 8% for the Corail group while 1% for the Tri-Lock (BPS) group (8% vs 1%, P = 0.030). At final follow-up, no statistical differences in regard to HHS, WOMAC, and Pain VAS were revealed between the two groups (P > 0.05). The rate of thigh pain was higher in Corail group than in Tri-lock (BPS) group (5% vs 0%, P = 0.043). However, incidence of stress shielding in grade 1 was higher in Tri-Lock (BPS) than in the Corail group (76% vs 23%, P < 0.01), while those in grade 2 and 3 were lower compared to the Corail stem (15% vs 28%, P < 0.01; 9% vs 16%, P = 0.008, respectively). Intriguingly, other assessments in relation to radiographic outcomes and postoperative complications were not comparable between the two groups. The Kaplan-Meier survival rate (revision surgery performed for any reason was defined as the end point) was similar between the two groups (P = 0.57), with 98.8% (95% confidence interval, 92.3%-100%) in Tri-lock (BPS) group and 97.6% (95% confidence interval, 94.6%-100%) in Corail group.

CONCLUSIONS: The Tri-Lock (BPS) has similar clinic performances compared to the Corail stem. Furthermore, the Tri-lock (BPS) stem has some advantages in achieving lower incidence of thigh pain, stress shielding and intra-operative fracture. Therefore, we recommend the Tri-lock (BPS) stem as a good alternative in primary total hip arthroplasty, especially taking into account patient factors, including bone deficiency and convenience of extraction of the stem in hip revision.

PMID:33675168 | DOI:10.1111/os.12946