Tag: pubmed

Clin Nutr. 2021 Oct 22;40(12):5764-5770. doi: 10.1016/j.clnu.2021.10.012. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Body weight changes reflect and impact several health conditions in older age, but little is known about its relationship with multimorbidity. We aimed to study the association of long-terms trajectories of body mass index (BMI) with contemporaneous changes in multimorbidity -and multimorbidity type- development in a population-based cohort of older adults.

METHODS: Twelve-year BMI trajectories (2001-2013) were identified in subjects aged 60+ years from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) using growth mixture models (N = 2189). Information on 60 chronic diseases and multimorbidity was ascertained based on clinical examinations, lab tests, medications, and inpatient and outpatient medical records. Linear mixed models were used to study the association between BMI trajectories and the speed of chronic disease accumulation, in general and by groups of cardiovascular and neuropsychiatric diseases.

RESULTS: Eighty percent of the study population was included in what we defined a stable BMI trajectory, 18% in a slow-decline trajectory with an accelerated BMI decline from age 78 onwards, and 2% in a fast-decline trajectory that reached underweight values before age 85. A significantly higher yearly rate of chronic disease accumulation was observed in the fast-decline versus stable trajectory (β = 0.221, 95% CI 0.090-0.352) after adjusting the model for age cohort, sex, education and time to death. Subjects in the slow-decline trajectory showed a significantly higher yearly rate of cardiovascular disease accumulation (β = 0.016, 95% CI 0.000-0.031); those in the fast-decline trajectory showed a faster accumulation of both cardiovascular (β = 0.020, 95% CI -0.025, 0.064) and neuropsychiatric diseases (β = 0.102, 95% CI 0.064-0.139), even if the former association did not reach statistical significance.

CONCLUSION: Our results provide further evidence of the importance of carefully monitoring older adults with sustained weight loss, which is an early indicator of accelerated health deterioration, reflected in our study by a faster accumulation of chronic -especially neuropsychiatric- diseases.

PMID:34763261 | DOI:10.1016/j.clnu.2021.10.012

Epilepsy Res. 2021 Sep 24;178:106772. doi: 10.1016/j.eplepsyres.2021.106772. Online ahead of print.

ABSTRACT

BACKGROUND: Depression, being the most frequent psychiatric comorbidity, has always been closely linked with epilepsy. However, there is a lack of screening for depressive symptoms resulting in failure to detect depression among people with epilepsy (PWE). While many studies have described the risks associated with depression in epilepsy, very few have elaborated whether these risks are similar for undiagnosed depression, especially in a multiethnic community.

METHODS: We aim to investigate the prevalence and associated risk factors of undiagnosed depression in PWE through a cross-sectional study at a tertiary teaching hospital. Epilepsy patients aged between 18 and 65 years old were recruited after excluding those with background illnesses, which may contribute to depressive symptoms. A total of 129 participants were recruited. We collated their demographic and clinical details before interviewing them using two questionnaires; the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Beck’s Depression Inventory-II (BDI-II). Subsequently, if a participant is screened positive for depression, the diagnosis is confirmed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) questionnaire and a psychiatric clinic referral is offered.

RESULTS: Among the 129 participants, 9.3 % had undiagnosed major depressive disorder (MDD), which had a female preponderance (66.7 %). Risk factors of undiagnosed depression among PWE include low socioeconomic backgrounds (p = 0.026), generalized epilepsy (p = 0.036) and temporal lobe epilepsy (p = 0.010). Otherwise, while some variables such as being underweight and unmarried may be seen in a higher proportion in those who were depressed; we did not find a statistically significant relationship among them.

CONCLUSION: The prevalence of undiagnosed depression among PWE is higher when compared to population-based studies carried out in Western countries. While questionnaires to screen for depression are widely available, their infrequent use would lead to failure in identifying patients who may benefit from psychosocial support and treatment, which would subsequently improve their disease outcomes and quality of life. This study recommends the use of screening questionnaires to identify undiagnosed depression in PWE.

PMID:34763265 | DOI:10.1016/j.eplepsyres.2021.106772

Am J Emerg Med. 2021 Nov 2;51:197-201. doi: 10.1016/j.ajem.2021.10.041. Online ahead of print.

ABSTRACT

BACKGROUND: Malnutrition is an important contributing factor to mortality in cancer patients. Several scoring systems can be used to evaluate malnutrition in cancer patients. We hypothesized that one or more of these scoring systems should be used to assess malnutrition in emergency departments (EDs).

METHODS: This prospective observational study was conducted in the ED of a tertiary care center. From October 1, 2019, to March 31, 2020, we prospectively collected data on cancer patients aged 18 and over who were evaluated in the ED but did not present with any nutrition-related complaint, and not had any prior nutritional support. Malnutrition levels were determined using the Patient-Generated Subjective Global Assessment (PG-SGA¹) instrument. The patients were grouped according to the presence and degree of malnutrition (PG-SGA categories A and B vs PG-SGA category C) and their need for nutritional intervention according to the Nutritional Triage Recommendation Scores (NTRS² < 9 vs NTRS ≥9).

RESULTS: Twelve female (31.5%) and 26 male (68.5%) cancer patients, with a mean age of 70.29 ± 11.49 years, were enrolled in the study. According to the PG-SGA, 84.2% of the patients were at risk for malnutrition, and 97.4% required nutritional intervention. Thirty patients (78.9%) had experienced problems with eating in the preceding two weeks. There were statistically significant differences in these patients’ body mass indexes (BMIs) (25.46 ± 4.3 kg/m² vs 20.95 ± 3.66 kg/m², p < 0.05) and ages (64.6 ± 10.5 years vs 74.9 ± 10.3 years, p < 0.05) according to the PG-SGA. There were also statistically significant differences between the patients’ BMIs (25.73 ± 3.51 kg/m² vs 22.11 ± 4.50 kg/m², p < 0.05), according to the NTRS. There was no relationship between whether the patients had undergone surgery to remove tumors (p > 0.05), chemotherapy (p > 0.05), or radiotherapy (p > 0.05) according to the PG-SGA and NTRS.

CONCLUSION: Malnutrition is common in cancer patients. These patients may be malnourished even if their BMI is within normal limits. Malnutrition can be detected and evaluated in the ED using instruments such as the PG-SGA. We suggest that evaluation for malnutrition should be a standard component of patient care in the ED.

PMID:34763239 | DOI:10.1016/j.ajem.2021.10.041

Neural Netw. 2021 Oct 23;145:189-198. doi: 10.1016/j.neunet.2021.10.015. Online ahead of print.

ABSTRACT

In this paper, the issue of synchronization is investigated for coupled neural networks subject to stochastic deception attacks. Firstly, a general differential inequality with delayed impulses is given. Then, the established differential inequality is further extended to the case of delayed stochastic impulses, in which both the impulsive instants and impulsive intensity are stochastic. Secondly, by modeling the stochastic discrete-time deception attacks as stochastic impulses, synchronization criteria of the coupled neural networks under the corresponding attacks are given. Finally, two numerical examples are provided to demonstrate the correctness of the theoretical results.

PMID:34763245 | DOI:10.1016/j.neunet.2021.10.015

Am J Emerg Med. 2021 Oct 24;51:192-196. doi: 10.1016/j.ajem.2021.10.029. Online ahead of print.

ABSTRACT

OBJECTIVES: There has been increased focus nationally on limiting opioid prescriptions. National data demonstrates a decrease in annual opioid prescriptions among emergency medicine physicians. We analyzed data from 2012 to 2020 from a large academic health system in California to understand trends in opioid prescribing patterns for emergency department (ED) discharged patients and assessed the potential impact of two initiatives at limiting local opioid prescriptions.

METHODS: In 2012-2020, monthly ED visit data was used to evaluate the total number of outpatient opioid prescriptions and percent of ED visits with opioid prescriptions (as primary outcomes). Descriptive statistics, graphic representation, and segmented regression with interrupted times series were used based on two prespecified time points associated with intensive local initiatives directed at limiting opioid prescribing1) comprehensive emergency medicine resident education and 2) electronic health record (EHR)-based intervention.

RESULTS: Between March 2012 and July 2020, a total of 41,491 ED discharged patients received an opioid prescription. The three most commonly prescribed drugs were hydrocodone (84.1%), oxycodone (10.8%), and codeine (2.8%). After implementing comprehensive emergency medicine resident education, the total number of opioid prescriptions, the percentage of opioid prescriptions over total ED visit numbers and the total tablet number showed decreasing trends (p’s ≤ 0.01), in addition to the natural (pre-intervention) decreasing trends. In contrast, later interventions in the EHR tended to show attenuated decreasing trends.

CONCLUSIONS: From 2012 to 2020, we found that total opioid prescriptions decreased significantly for discharged ED patients. This trend is seen nationally. However, our specific interventions further heightened this downward trend. Evidence-based legislation, policy changes, and educational initiatives that impact prescribing practices should guide future efforts.

PMID:34763238 | DOI:10.1016/j.ajem.2021.10.029

Am J Emerg Med. 2021 Oct 24;51:184-191. doi: 10.1016/j.ajem.2021.10.031. Online ahead of print.

ABSTRACT

INTRODUCTION: Cardiopulmonary arrest (CPA) care in the Emergency Department (ED) has had to be modified during the coronavirus disease (COVID-19) pandemic. Scarce literature exists on comfort of clinicians (defined as physicians, nurses & advanced practice providers-APP’s) in these new roles and their perceived understanding of new algorithms.

METHODS: Routine CPA care in our ED was modified during the COVID-19 pandemic. This involved clinicians in shared leadership roles alongside COVID-19 specific changes to CPA algorithms. The new protocol was operationalized through a two-step educational intervention involving didactic education and in-situ simulations. Univariate analyses using student’s t-test assessed effectiveness of this educational intervention with clinician comfort as team leaders and perceived knowledge as primary outcomes on a scale of 1 (strongly disagree) to 5 (strongly agree). Subgroup analysis across physicians (attending & resident), nurses & APP’s were also undertaken with an alpha of 0.05, and p values <0.05 were considered statistically significant. Secondary outcomes of task saturation, procedural safety and error prevention were also analyzed.

RESULTS: Across 83 of 95 total participants, our primary outcome of clinician comfort in the team leader role improved from a mean value of 3.41 (SD: 1.23) pre-intervention to 4.11 (SD: 0.88) with a p-value <0.001 post intervention. Similar and statistically significant findings in clinician comfort were noted across all subgroups except attending physicians and APP’s. Perceived knowledge increased from a mean value of 3.54 (SD: 1.06) pre-intervention to a mean value of 4.24 (SD: 0.67) with a p-value <0.001 post intervention. Similar and statistically significant findings in perceived knowledge were noted across all subgroups except APP’s. Responses were registered in either the strongly agree or agree category with regards to task saturation (89%), procedural safety (93%) and error prevention (71%) across all clinicians post intervention.

CONCLUSION: Our pilot investigation of the effectiveness of an educational intervention of a novel CPA protocol in the ED during the COVID-19 pandemic reached statistical significance with regards to clinician comfort in shared leadership roles and perceived knowledge. These findings suggest that the protocol is rapidly teachable, usable and can be efficiently disseminated across ED clinicians of varying experience, especially in pandemic settings. Further work regarding effectiveness of this new protocol in real life cardiac arrest scenarios is warranted.

PMID:34763237 | DOI:10.1016/j.ajem.2021.10.031

Eur J Oncol Nurs. 2021 Oct 21;55:102060. doi: 10.1016/j.ejon.2021.102060. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to explore the level of stress perceived and quality of life (QOL) by gynaecologic cancer (GC) patients and family caregivers’ dyads.

METHODS: In this cross-sectional study, 86 dyads were recruited from the gynaecological oncology department of a general hospital in Taichung City, Taiwan. The patients and family caregivers completed a sociodemographic information sheet, the Perceived Stress Scale, and the Taiwanese version of World Health Organization Quality of Life-BREF questionnaire. Data were analysed using descriptive statistics and Pearson’s correlations. This study used the actor-partner interdependence model (APIM) with distinguishable dyads to examine the effect of patients’ and caregivers’ perceived stress on QOL in patient-caregiver dyads.

RESULTS: GC patients’ and caregivers’ level of QOL was influenced by their own stress level (actor effect). Caregivers’ stress was statistically negatively associated with the patients’ QOL (partner effect); however, there were no partner effect from GC patients to caregivers. Both patients and family caregivers with higher perceived stress had poorer QOL. Therefore, we identified that stress has some level of actor and partner effects on QOL in GC patient-family caregiver dyads.

CONCLUSIONS: Family caregivers’ stress displayed both actor and partner effects within the first year of the cancer diagnosis; therefore, patient-and caregiver-based interventions, such as stress reduction strategies, should be developed to enhance patients’ and caregivers’ QOL and stress management ability.

PMID:34763206 | DOI:10.1016/j.ejon.2021.102060

Comp Immunol Microbiol Infect Dis. 2021 Oct 28;79:101717. doi: 10.1016/j.cimid.2021.101717. Online ahead of print.

ABSTRACT

The present study was conducted to compare the S. aureus isolates from different sources in the basis of resistance phenotypic and genotypic features and phylogenetic differences. Total of 70 S. aureus isolates (including 25 human, 25 raw milk and 20 pet animal isolates) were subjected to the antimicrobial susceptibility testing, polymerase chain reaction (PCR) detection of the resistance genes and DNA fingerprinting using random amplification of polymorphic DNA-PCR (RAPD-PCR) to survey the variability of the isolates. Among 70 S. aureus, 55 (78.5%) isolates were MRSA. The isolates showed the highest antibiotic resistance to methicillin, ampicillin and penicillin (78.5%) and showed the lowest resistance to ciprofloxacin (12.8%). ErmB and tetM resistance genes were present in all isolates and the vanA gene was not detected in any of the isolates. Thirteen distinct clusters were identified in RAPD-PCR fingerprinting. Statistical analysis showed that the isolates without resistance to antibiotics were significantly in associated with raw milk origin (P < 0.05). According to the results of the study, S. aureus strains with pets and raw milk origin are significant sources of antibiotic-resistant isolates such as MRSA. They are also carriers of resistance genes that can be transmit to human isolates and cause drug resistance in human infections. Identifying the source of these infections is possible with a reliable genotyping method such as RAPD-PCR.

PMID:34763201 | DOI:10.1016/j.cimid.2021.101717

J Psychosom Res. 2021 Oct 28;151:110659. doi: 10.1016/j.jpsychores.2021.110659. Online ahead of print.

ABSTRACT

INTRODUCTION: A hyper-coagulant state is a biological mechanism that triggers cardiac events in patients with coronary artery disease (CAD). Depressive symptoms and anxiety predict an unfavourable course of CAD. The SPIRR-CAD-RCT examined the effects of a psychological intervention and provided the opportunity to explore cross-sectional associations between indices of psychological strain and coagulation parameters, as well as prospective changes in depression scores and coagulation parameters.

METHODS: In this secondary analysis, we investigated 253 CAD patients (194 male; age m 58.9, SD 8.3 yrs.) with mild to moderate depression (≥8 on the HADS-D) at baseline and at follow-up 18 months later: TF, fibrinogen, D-dimer, VWF, FVII and PAI-1 and the course of depression (HAM-D), vital exhaustion (VE) and anxiety scores (HADS-A) were examined by ANOVA in the total and younger age groups (≤ 60).

RESULTS: HAM-D at baseline was correlated with TF (corr. R² = 0.27; F = 9.31, p = 0.001). HADS anxiety was associated with fibrinogen (corr. R².20; F = 7.27, p = 0.001). There was no detectable therapeutic effect on coagulation. Fibrinogen and VWF decreased within 18 months (time effect; p = 0.02; p = 0.04), as did HADS-D in both treatment groups (p < 0.001). Fibrinogen decreased more in patients ≤60 years with high VE compared to low VE (interaction time x group, p = 0.01).

CONCLUSIONS: This is the first study to show an association between TF and depression. Coagulation parameters as potential mediators of CAD progression correlated cross-sectionally with depression and anxiety and prospectively with VE. Further studies should replicate these correlations in depressed and non-depressed CAD patients.

ISRCTN: 76240576; clinicaltrials.gov.

PMID:34763203 | DOI:10.1016/j.jpsychores.2021.110659

Anaesth Crit Care Pain Med. 2021 Nov 8:100980. doi: 10.1016/j.accpm.2021.100980. Online ahead of print.

NO ABSTRACT

PMID:34763142 | DOI:10.1016/j.accpm.2021.100980