Tag: pubmed

J Vasc Surg Venous Lymphat Disord. 2021 Jun 23:S2213-333X(21)00304-8. doi: 10.1016/j.jvsv.2021.06.009. Online ahead of print.

ABSTRACT

OBJECTIVES: Instent restenosis (ISR) and stent compression (SC) are problems encountered following stenting for chronic iliofemoral venous obstruction (CIVO) that are responsible for a majority of reinterventions. However, characteristics of ISR and SC, in addition to outcomes following reintervention have not been explored in detail and represent the focus of this study.

METHODS: A retrospective analysis of contemporaneously entered EMR data on 578 limbs/patients with initial unilateral iliofemoral venous stents placed from 2014 to 2018 was performed. ISR was estimated from stent and flow channel diameters measured using duplex ultrasound (DUS). SC was estimated from rated stent diameter and actual stent diameter on DUS. Characteristics evaluated included onset of ISR/SC post stent placement and progression over time. Analysis was performed to evaluate risk factors for the development of ISR and SC. Outcomes following reintervention for ISR/SC were also appraised.

RESULTS: 578 limbs underwent stenting for stenotic lesions (NIVL/PTS). ISR was noted in 27% of limbs on post-intervention day 1. The prevalence of ISR increased to 74% by 3 months and stabilized thereafter. SC was noted in 80% of limbs on day 1 and plateaued. Of the variables evaluated as potential risk factors for ISR, IVUS determined stent inflow luminal area and shear rate were found to be significant. For SC, asymmetric stent sizing was a significant risk factor. Over a median follow up of 24 months, 95/578 (16.4%) limbs underwent reintervention for ISR, SC or a combination. The median time to reintervention was 11 months. There was no statistically significant difference in the degree of ISR/SC among patients who underwent reintervention versus those who did not [p>0.05]. However, there was a statistically significant difference in the grade of swelling (p=0.006) and VAS pain scores (p<0.0001) between those who underwent reintervention and those who did not. Primary, primary assisted and secondary patencies at 60 months, following reintervention for ISR was 70%, 98% and 84% respectively, and for SC was 70%, 99% and 84%.

CONCLUSIONS: While ISR and SC are both common following stenting for CIVO, neither are relentlessly progressive. Indication for reintervention must be a recurrence of symptoms with impairment of quality of life and not the percentage of ISR or degree of SC. Post reintervention good outcomes can be expected both in terms of clinical improvement and stent patency. Further study of the impact of shear rate on stent flow is required to help reduce the incidence of ISR.

PMID:34174500 | DOI:10.1016/j.jvsv.2021.06.009

Nurse Educ Today. 2021 Jun 17;105:105017. doi: 10.1016/j.nedt.2021.105017. Online ahead of print.

ABSTRACT

BACKGROUND: In high fidelity simulation used in an educational context, measuring the psychological safety levels of students enables the understanding and analysis of the relation between the characteristics of simulation design and the factors that create a psychologically safe environment.

OBJECTIVE: To develop a new measurement of psychological safety in simulation-based learning settings using high fidelity manikins and to validate its reliability and validity.

METHODS: This is a methodological study to develop a scale of Psychological Safety in High Fidelity Simulation. A convenience sample of 242 participants recruited from four universities in Korea was analyzed. The content validity of the scale and feasibility test were conducted to assess the scale’s relevance, and comprehensiveness. An exploratory factor analysis with the principal component method and a varimax rotation, a concurrent validity analysis, and known group comparisons were conducted. Reliability was evaluated through the scale’s internal consistency.

RESULTS: Four factors were extracted, and 14 items were retained for these four factors, accounting for 72% of the total variance: (1) “Dealing with uncertainty (four items),” (2) “being exposed (four items),” (3) “being unsupported (three items),” and (4) “interpersonal risk (three items).” The Psychological Safety in High Fidelity Simulation scale score exhibited a statistically significant positive correlation with the Academic Safety Assessment tool and the Educational Satisfaction Scale in Simulation scores (p 〈001). Cronbach’s α was .91 and ranged from .75 to .88 for the sub-factors.

CONCLUSION: The Psychological Safety in High Fidelity Simulation scale is a reliable and valid tool for assessing the psychological safety of nursing students during high fidelity simulation. The scale reflects the nature of psychological safety based on the elements of simulation education and measures the degree to which specific guidance is useful for nursing educators fostering psychological safety in students.

PMID:34174511 | DOI:10.1016/j.nedt.2021.105017

Eur J Radiol. 2021 Jun 17;141:109826. doi: 10.1016/j.ejrad.2021.109826. Online ahead of print.

ABSTRACT

BACKGROUND: Atypical lesions found on percutaneous breast biopsy raise specific management issues. The aim of this study was to validate the previous performance of a decision tree defined by Forgeard et al to select a subset of patients at low-risk of surgical diagnostic upgrade that would be eligible for surveillance.

METHODS: A consecutive series of 211 patients diagnosed with ADH on vacuum-assisted biopsy (VAB) of clustered microcalcifications alone, then operated in our institution, was reviewed. Histological findings on percutaneous cores were compared with definitive diagnoses on surgical specimens. The rate of cancer underestimation on VAB was analyzed in the four arms and two management attitudes defined in the scheme, using size and quality of microcalcification removal and the number of ADH foci.

RESULTS: Ninety-eight women with ADH met the inclusion criteria. Overall, 20 cancers were diagnosed at surgery, showing a malignancy rate of 44% (17/39 patients) in the surgery group and of 5% (3/59 patients) in the surveillance group, which was not significantly different from the 2% rate in the monitored reference group (p > 0.64). The malignancy rate increased significantly with the size of clustered microcalcifications (0% when < 6mm, 17% when between 6mm and 21 mm, 48% when > 21 mm, p < 0001) and the number of ADH foci on VAB (14% when ≤ 2, 45% when > 2, p < 0.005).

CONCLUSION: Our results corroborate – within the limits of large confidence intervals – those obtained with the reference decision tree. Due to statistical uncertainty, however, they need to be prospectively validated in a broader series.

PMID:34174485 | DOI:10.1016/j.ejrad.2021.109826

Eur J Radiol. 2021 May 17;141:109778. doi: 10.1016/j.ejrad.2021.109778. Online ahead of print.

ABSTRACT

PURPOSE: To assess correlations of lean body weight (LBW) calculated with various formulas, total body weight (TBW), body height (BH), body mass index (BMI), body surface area (BSA) and fat-free mass (FFM) with vascular and parenchymal enhancement in multiphasic CT of the liver.

METHOD: Thirty consecutive patients underwent multiphasic CT of the liver using constant iodine dose and flow rate. Contrast enhancement of aorta, portal vein and liver was calculated by measuring mean vascular and parenchymal attenuation in pre-contrast and post-contrast phases. Correlations of TBW, BH, BMI, BSA, FFM, and LBW (calculated with formulas of Boer, Hume, James and Green&Duffull) with enhancement were tested using Spearman’s correlation coefficient. The method of Fieller et al. was used to calculate 95 % confidence intervals. A p-value ≤ 0.05 was considered statistically significant.

RESULTS: Aortal enhancement correlated strongly with TBW, BSA, LBW_Boer and LBW_Hume and moderately with BH, BMI, FFM, LBW_James and LBW_{Green&Duffull}. Liver enhancement in the late arterial phase correlated moderately with TBW, FFM, LBW_Boer, LBW_Hume and LBW_{Green&Duffull} and weakly with BSA. Liver enhancement in the portal venous phase correlated strongly with TBW, BSA, FFM, LBW_Boer, LBW_Hume and LBW_{Green&Duffull}, whereby overlap of the 95 % CI graphs demonstrated that the differences in the correlation coefficients were not statistically significant. Liver enhancement in the delayed phase correlated moderately with BH but did not correlate significantly with any other parameter.

CONCLUSION: Regardless of the form used for calculation, LBW did not correlate statistically significantly stronger than TBW with vascular or parenchymal enhancement of the liver.

PMID:34174486 | DOI:10.1016/j.ejrad.2021.109778

J Affect Disord. 2021 Jun 18;293:64-70. doi: 10.1016/j.jad.2021.06.017. Online ahead of print.

ABSTRACT

BACKGROUND: Premenstrual syndrome (PMS) and depression co-occur frequently; however, their relationship remains controversial. This study was conducted primarily to discern heterogeneous patterns of such co-occurring symptoms in Chinese female university students, using a latent profile analysis (LPA), a person-centered statistical approach.

METHODS: The PMS Scale and Beck Depression Inventory were used to examine self-reported PMS and depression symptoms in 701 Chinese female university students. LPA, multinomial logistical regression, and analyses of variance were adopted to investigate latent profiles and their validity.

RESULTS: The LPA results indicated that a four-class solution characterized by low symptoms (57.2%), predominantly PMS (11.3%), predominantly depression (23.7%), and combined PMS-depression (7.8%) patterns fitted the data best. Age, first menstrual experience, and personality factors were associated with differences in nonparallel profiles characteristic of menstrual attitude.

LIMITATIONS: Use of self-report measures can lead to response biases; the cross-sectional design at a single time point limits the examination of changes in symptom characteristics and members within the category over time; and the specific age group limits the generalizability of results.

CONCLUSION: These results confirm that PMS is independent from depression, rather than a variant of depression, and can be used to resolve the controversy regarding the relationship between PMS and depression. The current findings highlight the need for identifying women at high risk for PMS and depression, and promoting interventions individually tailored to their symptom presentations.

PMID:34174472 | DOI:10.1016/j.jad.2021.06.017

Hear Res. 2021 Jun 17;408:108296. doi: 10.1016/j.heares.2021.108296. Online ahead of print.

ABSTRACT

Long-latency mismatch responses to oddball stimuli have recently been observed from anaesthetised rodents. This electrophysiological activity is viewed through 200 to 700 ms post-stimulus; a window that is typically obstructed from analysis by the response to subsequent stimuli in the auditory paradigm. A novel difference waveform computation using two adjoining evoked responses has enabled visualisation of this activity over a longer window than previously available. In the present study, this technique was retroactively applied to data from 13 urethane-anaesthetised mice. Oddball paradigm waveforms were compared with those of a many-standards control sequence, confirming that oddball stimuli evoked long-latency potentials that did not arise from standard or control stimuli. Statistical tests were performed to identify regions of significant difference. Oddball-induced mismatch responses were found to display significantly greater long-latency potentials than identical stimuli presented in an equal-probability context. As such, it may be concluded that long-latency potentials were evoked by the oddball condition. How this feature of the anaesthetised rodent mismatch response relates to human mismatch negativity is unclear, although it may be tentatively linked to the human P3a component, which emerges downstream from mismatch negativity under certain conditions. These results demonstrate that the time dynamics of mismatch responses from anaesthetised rodents are more extensive than previously considered.

PMID:34174482 | DOI:10.1016/j.heares.2021.108296

Osteoarthritis Cartilage. 2021 Jun 23:S1063-4584(21)00810-4. doi: 10.1016/j.joca.2021.06.004. Online ahead of print.

ABSTRACT

OBJECTIVE: Current global guidelines regarding the first-line analgesics (acetaminophen, topical or oral non-steroidal anti-inflammatory drugs [NSAIDs]) for knee osteoarthritis remain controversial and their comparative risk-benefit profiles have yet to be adequately assessed.

DESIGN: Pubmed, Embase, Cochrane Library, and Web of Science were searched from database inception to March 2021 for randomized controlled trials (RCTs) comparing acetaminophen, topical NSAIDs and oral NSAIDs directly or indirectly in knee osteoarthritis. Bayesian network meta-analyses were conducted. A propensity-score matched cohort study was also conducted among patients with knee osteoarthritis in The Health Improvement Network database.

RESULTS: 122 RCTs (47,113 participants) were networked. Topical NSAIDs were superior to acetaminophen (standardized mean difference [SMD]=-0.29, 95% credible interval [CrI]: -0.52 to -0.06) and not statistically different from oral NSAIDs (SMD=0.03, 95% CrI: -0.16 to 0.22) for function. It had lower risk of gastrointestinal adverse effects (AEs) than acetaminophen (relative risk [RR]=0.52, 95%CrI: 0.35 to 0.76) and oral NSAIDs (RR=0.46, 95%CrI: 0.34 to 0.61) in RCTs. In real-world data, topical NSAIDs showed lower risks of all-cause mortality (hazard ratio [HR]=0.59, 95% confidence interval [CI]: 0.52 to 0.68), cardiovascular diseases (HR=0.73, 95%CI: 0.63 to 0.85) and gastrointestinal bleeding (HR=0.53, 95%CI: 0.41 to 0.69) than acetaminophen during the one-year follow-up (n=22,158 participants/group). A better safety profile was also observed for topical than oral NSAIDs (n=14,218 participants/group).

CONCLUSIONS: Topical NSAIDs are more effective than acetaminophen but not oral NSAIDs for function improvement in people with knee osteoarthritis. Topical NSAIDs are safer than acetaminophen or oral NSAIDs in trials and real-world data.

PMID:34174454 | DOI:10.1016/j.joca.2021.06.004

Osteoarthritis Cartilage. 2021 Jun 23:S1063-4584(21)00808-6. doi: 10.1016/j.joca.2021.06.002. Online ahead of print.

ABSTRACT

OBJECTIVE: We evaluated whether patient-reported outcome trajectories (i.e., changes over time) differed by intraoperative compartmental cartilage lesion pattern over 4-6 years following arthroscopic meniscal surgery.

METHODS: In this ancillary study of the Knee Arthroscopy Cohort Southern Denmark cohort, we intraoperatively categorized cartilage lesions as isolated patellofemoral, isolated tibiofemoral, or combined patellofemoral/tibiofemoral. Participants completed the Knee injury and Osteoarthritis Outcome Score (KOOS) pre-operatively, at 3 and 12 months, and at 4-6 years post-operatively and reported overall satisfaction at final follow-up. Our main outcome was KOOS₄ (grand mean of four subscale means). We evaluated whether KOOS₄ scores changed over time according to cartilage lesion patterns using adjusted mixed linear regression. We also estimated probability of treatment satisfaction using logistic regression.

RESULTS: Of 630 participants with complete cartilage scores, 280 (44%) were women, mean (standard deviation) age was 49 (13) years, and BMI was 27.3 (4.4) kg/m². KOOS₄ scores at baseline were slightly lower in all lesion groups compared to the no lesion group, yet only the combined group was statistically significantly lower. KOOS₄ trajectories were similar across cartilage lesion patterns, but by final follow-up, adjusted mean KOOS₄ scores were 6.8 (95% CI 2.2, 11.4) to 9.8 (1.1, 18.5) points lower in groups with cartilage lesions compared to the no lesion group. Probability of patient-reported satisfaction did not differ statistically by group.

CONCLUSIONS: Though KOOS₄ scores were slightly lower in groups with arthroscopically assessed cartilage lesions compared to the no lesion group, trajectories were similar across all groups.

PMID:34174456 | DOI:10.1016/j.joca.2021.06.002

West Afr J Med. 2021 Jun 26;38(6):520-525.

ABSTRACT

BACKGROUND: Poor medication adherence in HIV treatment is a public health problem as it leads to increased morbidity and mortality, as well as the development of drug resistance. There is limited information on the determinants of adherence among people living with HIV/AIDS especially in sub-Saharan Africa. This study aimed at assessing the determinants of adherence to HAART among people living with HIV/AIDS in Lagos State, Nigeria.

METHODS: A descriptive cross-sectional survey was conducted among 302 respondents selected from three public health facilities across the state. The study instrument was an interviewer-administered questionnaire adapted from the Medication Adherence Report Scale (MARS). Data analysis was performed using Epi Info software. Logistic regression analysis was used to identify the determinants of adherence. Level of significance for all the tests was set at p-value <0.05.

RESULTS: Seventy percent of respondents reported being adherent to medication. There were statistically significant associations between respondents’ age, having children, good knowledge of HIV and medication adherence. In addition, it was observed that the type of anti-retroviral (ARV) drug schedule, never missing an appointment, belonging to a support group and disclosure of status were associated with HAART adherence. Controlling for other variables, those that had disclosed their status were twice as likely to adhere to HIV medication (aOR: 2.3; 95% CI: 1.1-4.8). Also, those who had never missed a clinic appointment were three times more likely to adhere to prescribed medication (aOR: 3.4; 95% CI: 1.7-6.5).

CONCLUSION: Disclosure of HIV status and clinic attendance were key determinants of adherence among patients on HAART in Lagos, Nigeria.

PMID:34174178

West Afr J Med. 2021 Jun 26;38(6):526-530.

ABSTRACT

BACKGROUND: Abdominal myomectomy is a treatment modality for uterine fibroids. Its outcome depends on related variables which include the size, number and location of the fibroids, age of the patient, surgery and method used to secure haemostasis.

OBJECTIVE: To determine the outcomes of abdominal myomectomies and related variables in a fertility centre in South-south Nigeria.

METHODS: A retrospective study of the records of all cases of abdominal myomectomies performed between August 1, 2010 and July 31, 2017. Medical records of the 146 patients who had abdominal myomectomy during the period under review were retrieved and relevant data extracted. Information collected included the presence or absence of intra-abdominal adhesions, duration of tourniquet use, number and weight of enucleated fibroid seedlings, intraoperative blood loss, complications and the number of patients who achieved pregnancy after myomectomy. Data were analyzed using ANALYSE IT® statistical package.

RESULTS: 146 patients underwent myomectomy during the period under review. The age range of the patients was 28-56 years (median 41 years). Almost all the patients (94.5%) had tourniquets applied to the uterus for hemostasis. The number of fibroids enucleated ranged from 1 to 154 and weighed between 0.02 and 2.8kg. Blood loss ranged from 100 to1500mls, 17.4% had post-operative fever, and one patient had bowel injury. Thirty-one patients (32.3%) who subsequently had in vitro fertilisation treatment achieved conception.

CONCLUSION: Fibroids, weighing >0.5kg, are associated with increased blood loss during abdominal myomectomy, and a previous myomectomy significantly increases the risk of adhesions. Careful patient selection and meticulous surgical techniques are necessary to avoid morbidity in this setting with a high rate of large uterine fibroids.

PMID:34174179