Tag: pubmed

J Head Trauma Rehabil. 2021 Jun 15. doi: 10.1097/HTR.0000000000000698. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine perceived injustice and its associations with self-reported symptoms and return to work at 3 months after injury in a prospectively recruited sample of patients with mild traumatic brain injury (mTBI).

DESIGN: Observational study.

SETTING: TBI outpatient unit.

PARTICIPANTS: Adult patients aged 18 to 68 years with mTBI (n = 100) or orthopedic injury ([OI]; n = 34).

MAIN MEASURES: The Injustice Experience Questionnaire (IEQ) and its associations with the Rivermead Post Concussion Questionnaire (RPQ), Beck Depression Inventory-Second Edition (BDI-II), PTSD Checklist-Civilian Version (PCL-C), and Pain Visual Analog Scale (PVAS). Information on injury-related characteristics, compensation seeking and litigation, and return-to-work status was also collected.

RESULTS: Median IEQ total score was 3 (range, 0-23) in the mTBI group and 2.5 (range, 0-25) in the OI group. In the mTBI group, IEQ was significantly correlated with RPQ (rs = 0.638, P < .01), BDI-II (rs = 0.612, P < .01), PCL-C (rs = 0.679, P < .01), and PVAS (rs = 0.232, P < .05). The association between IEQ and PCL-C (rs =0.797, P < .01) and BDI-II (rs = 0.395, P < .05) was also found in the OI group. In both groups, patients who were still on sick leave at 3 months after injury tended to report higher perceived injustice (IEQ total score) than patients who had returned to work or studies. However, this difference did not reach statistical significance.

CONCLUSIONS: Perceived injustice is associated with self-reported symptoms in patients with mTBI. Our results suggest that perceived injustice could be a relevant construct to consider in clinical management of patients with mTBI. Also, perceived injustice could be a potential target for psychological interventions promoting recovery after mTBI.

PMID:34145158 | DOI:10.1097/HTR.0000000000000698

J Head Trauma Rehabil. 2021 Jun 15. doi: 10.1097/HTR.0000000000000702. Online ahead of print.

ABSTRACT

OBJECTIVE: Balance deficits are common after concussions in pediatric patients. This study evaluates 3 clinical tools for identifying postconcussion balance deficits in a pediatric population: (1) Post-Concussion Symptom Scale (PCSS); (2) Balance Error Scoring System (BESS); and (3) physical examination measures of balance: tandem gait (TG) and Romberg test.

SETTING: Data were collected in a tertiary care outpatient pediatric sports medicine clinic.

PARTICIPANTS: English-speaking patients aged 8 to 17 years who presented to a tertiary care hospital-based pediatric sports medicine clinic and diagnosed with concussion between August 2014 and February 2018 were invited to participate. A total of 614 patients were screened and/or approached during the inclusion period and 500 were enrolled. Of those enrolled, 423 patients had complete data collected and analyzed.

DESIGN: This is a cross-sectional, observational data set from a longitudinal, prospective study.

MAIN MEASURES: Data extracted from patients’ electronic medical records included physical examination, PCSS, and BESS scores from their initial visit. Descriptive statistics were calculated for the outcome measures. A logistic regression was performed to evaluate significant contributors to abnormal BESS score (≥25).

RESULTS: There were 423 patients (56.7% female; 14.7 ± 2.01 years old) included in the study. Overall, we identified 336 patients (79.4%) with balance difficulties. Of the 336 with balance difficulties, 284 (84.5%) reported “balance problems” and/or “dizziness” on PCSS, 153 (45.5%) had abnormal BESS scores (≥25), and 100 (29.8%) had an abnormality on either TG or Romberg test.

CONCLUSION: Balance difficulties were identified in close to 80% of children with concussions. Using PCSS and BESS along with physical examination measures, TG and Romberg test, identified more patients with balance deficits than using TG and Romberg test alone.

PMID:34145162 | DOI:10.1097/HTR.0000000000000702

Anticancer Drugs. 2021 Jun 17. doi: 10.1097/CAD.0000000000001098. Online ahead of print.

ABSTRACT

Erlotinib is a tyrosine kinase inhibitor that inhibits epidermal growth factor receptor. It is being used for metastatic non-small cell lung cancer patients (NSCLC). Repurposing noncancer drugs for cancer treatment is a current issue and it has many advantages. We planned to reveal the effects of noncancer drugs [calcium channel blockers (CCBs) and others] on erlotinib. We scanned the files of NSCLC patients retrospectively who were applied to Karadeniz Technical University between January 2013 and April 2019 and used erlotinib. There were 63 patients, 9 of them were taking CCB simultaneously for arterial hypertension. We analyzed some parameters of these patients and their effects on overall survival (OS) and progression-free survival (PFS). A χ2 or Fisher’s exact test, Kaplan-Meier and Cox regressions were used in the statistical analysis. 12-month OS rates of CCB user and nonuser were 78.3 and 39.7%, respectively, [odds ratio (OR),0.14; 95% confidence interval (CI), 0.27-0.75; P = 0.023]. 24-month PFS rates of CCB user and nonuser were 44.4 and 8.3%, respectively (OR,0.11; 95% CI, 0.02-0.60; P = 0.016). There was 12-month OS and 24-month PFS advantage with simultaneously taking CCBs and erlotinib, they have an additive effect for NSCLC. This study will be inspiring future prospective studies.

PMID:34145175 | DOI:10.1097/CAD.0000000000001098

Saudi J Kidney Dis Transpl. 2021 Jan-Feb;32(1):209-217. doi: 10.4103/1319-2442.318526.

ABSTRACT

A wide range of causative organisms can cause acute pyelonephritis (APN). However, in recent times, these pathogens have increasingly become resistant to most of the antibiotics making treatment difficult. This was a prospective observational single-center study with a aim to study the microbiological spectrum, resistance patterns, and clinical outcome of patients with APN conducted in a private tertiary care hospital in India. All adult patients hospitalized in the department of nephrology at our institute with a diagnosis of APN from February 2016 to May 2017 were included. Patients <18 years of age, kidney-transplant recipients, and pregnant patients were excluded. Demographic details, clinical symptoms, signs, and radiological and laboratory data including urine and blood cultures of all patients were recorded. The details of treatment received and outcomes in hospital and after discharge were noted. Patients were followed up three months post discharge. Decision of antibiotic and duration of antibiotics was documented by treating nephrologists. Quantitative data were presented in terms of means and standard deviation. Student’s “t” test was used for comparison of quantitative outcome parameters. P <0.05 is considered statistically significant. SPSS software version 23.0 was used for statistical analysis. A total of 89 patients with a mean age of 50.33 ± 13.9 years, of which 61.8% were males and were studied; 82/89 had complicated pyelonephritis. The most common risk factor for APN was diabetes mellitus in 64 (72%). Most common symptom was fever in 80 (90%). A triad of fever, flank pain, and dysuria was present only in 27 (30.33%). Overall, 15 patients (16.8%) had severe pyelonephritis requiring intensive care unit admission. The most common organism isolated was Escherichia coli in 26/49 (53%), followed by Klebsiella pneumoniae in 12 (24.40%). Twenty-two (58%) isolates were extended-spectrum beta lactamase producers. Six (12.20%) were resistant to carbapenems and two (4%) were pan-resistant. All 89 were treated with intravenous antibiotics. Older patients, those with diabetes, with poor glycemic control, and with emphysematous pyelonephritis and patients in whom ESBL organisms were grown had poor outcome. Piperacillin tazobactam, aminopenicillins, cefoperazone sulbactam, and carbapenems (in severe pyelonephritis) can be considered as the empirical antibiotic of choice.

PMID:34145133 | DOI:10.4103/1319-2442.318526

Saudi J Kidney Dis Transpl. 2021 Jan-Feb;32(1):111-117. doi: 10.4103/1319-2442.318512.

ABSTRACT

Studies have reported high prevalence of inappropriate dosing in patients with renal impairment, which was significantly reduced with pharmacists’ interventions. The objective of this study was to assess the proportions of renal drug dosing errors following the implementation of pharmacists-led renal drug dosing adjustment program. This was a quasi-experimental study conducted at the King Abdul Aziz Medical City, a tertiary teaching hospital, Jeddah, Saudi Arabia. The study comprised of 3 phases. The pre-phase and post-phase evaluated drug orders for dosing appropriateness. During the intervention phase, a renal drug dosing adjustment program was implemented, which included educational sessions on dosing in renal insufficiency and a renal drug dosing guidance. The primary outcome was to assess the change in the proportions of dosing errors following the intervention. In the pre-phase, inappropriate dosing was noted in 20.1% (70/348) of orders that required dosing adjustment. Among the total dosing errors, 44.2% (31/70) were further corrected, and pharmacists have documented intervention in 48.3% (15/31) of the corrected orders. In the post-phase, inappropriate dosing was noted in 21.9% (76/346) of orders that required dosing adjustment. Among the total dosing errors, 39.4% (30/76) were further corrected, and pharmacists have documented intervention in 66.6% (20/30) of the corrected orders. There was no statistically significant difference in inappropriate drug dosing between pre-phase and post-phase with a P = 0.56. The intervention was not associated with significant reduction in renal dosing errors, although pharmacist involvement in the corrected orders orders increased after the implementation of the intervention. This may indicate the need to integrate renal dosing guidance into the hospital prescribing system to optimize drug dosing in renal patients.

PMID:34145120 | DOI:10.4103/1319-2442.318512

Saudi J Kidney Dis Transpl. 2021 Jan-Feb;32(1):128-136. doi: 10.4103/1319-2442.318514.

ABSTRACT

Immunosuppressive therapy is the backbone to renal transplantation. Although an adequate level of immunosuppression is required to dampen the immune response to the allograft, the level of chronic immunosuppression is slowly decreased over time (as the risk of acute rejection decreases) to help lower the overall risk of infection and malignancy. Several studies have discussed the clinical use of therapeutic drug monitoring of mycophenolic acid (MPA) in kidney transplant recipients. This prospective single-center study included 88 patients with end-stage renal disease who were transplanted in Mansoura Urology and Nephrology Center from living related donors, from the beginning of February 2016 to the end of December 2016. Eight patients were excluded, the remaining 80 patients were divided into two groups; the study group (40 patients) who were followed up using therapeutic trough level monitoring of MPA and, control group (40 patients) who were followed up using the fixed-dose of Mycophenolate according to our local immunosuppressive protocol. These patients were followed up for one year posttransplantation with regard to graft function, rejection episodes, gastrointestinal (GI), and hematological side effects, the incidence of infection or malignancy, patient survival, and graft survival. Fifteen patients from the study group (37.5%) needed dose reduction of MPA, no patients needed to increase the dose. Our study showed insignificant differences regarding the patients’ characteristics and demographic data. Significantly higher incidence of GI manifestations was noted in the control group (P = 0.001). Although the higher frequency of incidence of infection, anemia, leukopenia and thrombocytopenia was seen in the fixed- dose group, the difference was statistically insignificant. Regarding proteinuria and post-transplant diabetes mellitus, comparable data were obtained. Significantly higher percentage of recipients in the study group is still having normally functioning grafts (P = 0.02). Furthermore, higher percent of recipients in the control group died with functioning graft after one year of follow-up (P = 0.04). There were insignificant differences as regarding patient and graft survival. The decrease in the dose of MPA reduced the annual cost by around six thousand US dollars. Our results suggest that adopting therapeutic dose monitoring strategy during follow-up of kidney transplant recipients is adequate. Longer-term studies with a larger sample size may be needed to support this policy.

PMID:34145122 | DOI:10.4103/1319-2442.318514

Thorax. 2021 Jun 18:thoraxjnl-2020-216494. doi: 10.1136/thoraxjnl-2020-216494. Online ahead of print.

ABSTRACT

The incidence of and risk factors for recurrent hospitalisation for pneumonia were investigated using data from Hospital Episode Statistics, linked to a UK primary care database. Within 90 days and 1 year of follow-up, 1733 (3.1%) and 5064 (9.0%), developed recurrent pneumonia respectively. Smoking status at the time of hospitalisation with index pneumonia was associated with the risk of readmission with recurrent pneumonia within a year of discharge: current versus never smokers: adjusted subhazard ratio (sHR) 1.42, 95% CI 1.32 to 1.53, p<0.001, and ex smokers versus never smokers: adjusted sHR 1.24, 95% CI 1.15 to 1.34, p<0.001. Other independent risk factors associated with recurrent pneumonia were age, gender, deprivation and underlying comorbidities.

PMID:34145048 | DOI:10.1136/thoraxjnl-2020-216494

Indian J Med Res. 2020 Dec;152(6):648-655. doi: 10.4103/ijmr.IJMR_1582_18.

ABSTRACT

BACKGROUND & OBJECTIVES: As India and other developing countries are scaling up isoniazid preventive therapy (IPT) for people living with HIV (PLHIV) in their national programmes, we studied the feasibility and performance of IPT in terms of treatment adherence, outcome and post-treatment effect when given under programmatic settings.

METHODS: A multicentre, prospective pilot study was initiated among adults living with HIV on isoniazid 300 mg with pyridoxine 50 mg after ruling out active tuberculosis (TB). Symptom review and counselling were done monthly during IPT and for six-month post-IPT. The TB incidence rate was calculated and risk factors were identified.

RESULTS: Among 4528 adults living with HIV who initiated IPT, 4015 (89%) successfully completed IPT. IPT was terminated in 121 adults (3%) due to grade 2 or above adverse events. Twenty five PLHIVs developed TB while on IPT. The incidence of TB while on IPT was 1.17/100 person-years (p-y) [95% confidence interval (CI) 0.8-1.73] as compared to TB incidence of 2.42/100 p-y (95% CI 1.90-3.10) during the pre-IPT period at these centres (P=0.017). The incidence of TB post-IPT was 0.64/100 p-y (95% CI 0.04-1.12). No single factor was significantly associated with the development of TB.

INTERPRETATION & CONCLUSIONS: Under programmatic settings, completion of IPT treatment was high, adverse events minimal with good post-treatment protection. After ruling out TB, IPT should be offered to all PLHIVs, irrespective of their antiretroviral therapy (ART) status. Scaling-up of IPT services including active case finding, periodic counselling on adherence and re-training of ART staff should be prioritized to reduce the TB burden in this community.

PMID:34145105 | DOI:10.4103/ijmr.IJMR_1582_18

BMJ Open. 2021 Jun 18;11(6):e050948. doi: 10.1136/bmjopen-2021-050948.

ABSTRACT

INTRODUCTION: This research project addresses the lack of screening tools for the early detection of high-risk individuals for long-term care, through four individual studies.Study 1 investigates the predictive ability of the ‘Kihon Check List’, study 2 the ‘Cognitive Function instrument’ and EuroQol-5 Dimension (EQ-5D) and study 3 the ‘Cognitive Function instrument’ and EQ-5D as well as the ‘Frail Kenshin’ health check-up, for incident long-term care certification over a follow-up period of up to 4 years. This is the first large prospective study to evaluate the predictive ability of these tools for the outcome measure long-term care certification. The last subsection of this project study four aims to explore a mixed methods intervention for delaying the need for long-term care. This section is purely exploratory, looking for clues for further studies.

METHODS AND ANALYSIS: Baseline data have been collected through local government programs, as well as through postal self-reported questionnaires. The primary outcome variable for all studies is long-term care certification data. Statistical analysis will be carried out using Kaplan-Meier, Multiple Cox regression as well as logistic regression.

CONCLUSION: This project hopes to identify tools effective in predicting long-term care need. This will enable identification of citizens that are of higher risk for long-term care in the near future. This subset of high-risk individuals can in the future be addressed for extra support/intervention.

ETHICS AND DISSEMINATION: All studies have been approved by respective institutional ethical committees and the WHO ethical committee ERC.0002899. In addition, all studies conform to the provisions of the Declaration of Helsinki and are conducted in accordance with Japan’s ‘Ethical Guidelines for Medical and Health Research Involving Human Subjects’. All findings will be disseminated at conferences and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER: UMIN000023283.

PMID:34145022 | DOI:10.1136/bmjopen-2021-050948

BMJ Open. 2021 Jun 18;11(6):e051417. doi: 10.1136/bmjopen-2021-051417.

ABSTRACT

INTRODUCTION: The global COVID-19 pandemic continues to have wide-ranging implications for health, including psychological well-being. A growing corpus of research reviews has emerged on the topic of psychological resilience in the context of the pandemic. However, this body of work has not been systematically reviewed for its quality, nor with respect to findings on the effectiveness of tools and strategies for psychological resilience. To this end, a meta-review protocol is proposed with the following objectives: (1) identify review work on the topic of psychological resilience during COVID-19; (2) assess the quality of this review work using A MeaSurement Tool to Assess systematic Reviews; (3) assess the risk of bias in this work; (4) generate a narrative summary of the key points, strengths and weaknesses; (5) identify the psychological resilience strategies that have been reviewed; (6) identify how these strategies have been evaluated for their effectiveness; (7) identify what outcomes were measured and (8) summarise the findings on strategies for psychological resilience so far, providing recommendations, if possible.

METHODS AND ANALYSIS: A systematic meta-review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews for Protocols and Joanna Briggs Institute umbrella review guidelines. Electronic searches of general databases, especially Web of Science, Scopus and PubMed, will be conducted. Only results from January 2020 onwards will be considered, coinciding with the COVID-19 pandemic. Only results in English will be included. Descriptive statistics, thematic analysis and narrative summaries describing the nature of the reviewed work and evaluation of psychological resilience strategies will be carried out.

ETHICS AND DISSEMINATION: Ethical approval is not needed for systematic review protocols. The results of the meta-review will be published in an international peer-reviewed journal. The raw and summarised data will be shared in the journal or other open venues.

PROSPERO REGISTRATION NUMBER: CRD42021235288.

PMID:34145023 | DOI:10.1136/bmjopen-2021-051417