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Public Health Jun 2024COVID-19 revealed major shortfalls in healthcare workers (HCWs) trained in acute and critical care worldwide, especially in low-resource settings. We aimed to assess...
OBJECTIVES
COVID-19 revealed major shortfalls in healthcare workers (HCWs) trained in acute and critical care worldwide, especially in low-resource settings. We aimed to assess mass online courses' efficacy in preparing HCWs to manage COVID-19 patients and to determine whether rapidly deployed e-learning can enhance their knowledge and confidence during a pandemic.
STUDY DESIGN
Retrospective cohort study.
METHODS
This international retrospective cohort study, led by a large Academic Medical Centre (AMC), was conducted via YouTube and the AMC's online learning platform. From 2020 to 2021, multidisciplinary experts developed and deployed six online training courses based on the latest evidence-based management guidelines. Participants were selected through a voluntary sample following an electronic campaign. Training outcomes were assessed using pre-and post-test questionnaires, evaluation forms, and post-training assessment surveys. Kirkpatrick's Model guided training evaluation to measure self-reported knowledge, clinical skills, and confidence improvement. We also captured the number and type of COVID-19 patients managed by HCWs after the trainings.
RESULTS
Every 22.8 reach/impression and every 1.2 engagements led to a course registration. The 10,425 registrants (56.8% female, 43.1% male) represented 584 medical facilities across 154 cities. The largest segments of participants were students/interns (20.6%) and medical officers (13.4%). Of the 2169 registered participants in courses with tests, 66.9% completed post-tests. Test scores from all courses increased from the initial baseline to subsequent improvement post-course. Participants completing post-training assessment surveys reported that the online courses improved their knowledge and clinical skills (83.5%) and confidence (89.4%). Respondents managed over 19,720 COVID-19 patients after attending the courses, with 47.7% patients being moderately/severely ill.
CONCLUSIONS
Participants' confidence in handling COVID-19 patients is increased by rapidly deploying mass training to a substantial target population through digital tools. The findings present a virtual education and assessment model that can be leveraged for future global public health issues, and estimates for future electronic campaigns to target.
PubMed: 38941682
DOI: 10.1016/j.puhe.2024.05.006 -
Journal of Neurosurgery Jun 2024Recent work on ischemic cerebellar stroke has suggested that the resection of infarcted tissue may lead to improved functional outcomes compared with decompressive...
OBJECTIVE
Recent work on ischemic cerebellar stroke has suggested that the resection of infarcted tissue may lead to improved functional outcomes compared with decompressive surgery alone. Nonetheless, no studies have assessed the extent to which necrotic tissue should be resected or if there are any volumetric thresholds capable of predicting functional outcomes in this patient population. In this study, the authors aimed to determine potential thresholds for volume reduction in ischemic cerebellar stroke in an effort to optimize the management of ischemic cerebellar stroke and, in so doing, improve functional outcomes.
METHODS
This study is a multicentric retrospective study of patients who underwent surgery for the management of ischemic cerebellar stroke. Volumetric analyses of infarcted tissue present on CT scans were performed before and after surgical intervention(s). The final infarct volume (FIV) was computed as a percentage of the initial infarct volume (postoperative infarct volume/preoperative infarct volume × 100). The primary endpoint was functional outcome at 3 months, as determined by the modified Rankin Scale (mRS) score; mRS scores 0-2 were considered as favorable and mRS scores 3-6 as unfavorable. Receiver operating characteristic curves were used to explore the relationship between postoperative infarct volumes and FIV versus mRS score, and Youden's index was used to estimate potential volumetric thresholds.
RESULTS
A total of 91 patients were included in the study. The mean pre- and postoperative infarct volumes were 45.25 (SD 18.32) cm3 and 29.56 (SD 26.61) cm3, respectively. Patients undergoing necrosectomy, regardless of whether via craniotomy or craniectomy, were more likely to have a favorable outcome at discharge (OR 16.62, 95% CI 2.12-130.33; p = 0.008) and at 3 months (OR 24.12, 95% CI 3.03-192.18; p = 0.003) postoperatively. Postoperative infarct volumes ≤ 17 cm3 yielded a sensitivity of 77% and a specificity of 68% with regard to the prediction of favorable outcome at 3 months. The resection ≥ 50% of infarcted tissue was also predictive of favorable outcomes at 3 months (OR 7.7, 95% CI 2.7-21.8; p < 0.001).
CONCLUSIONS
The reduction of necrotic tissue volumes by at least 50% and/or the reduction of the infarct volume by ≤ 17 cm3 appear to be associated with favorable outcomes in patients with surgically managed ischemic cerebellar strokes.
PubMed: 38941630
DOI: 10.3171/2024.3.JNS232883 -
Research Quarterly For Exercise and... Jun 2024The present study investigated the effects of a 10-week preparatory training period on biomarkers and jumping performance and associations of changes in biomarkers,...
Anabolic/Catabolic Hormone Imbalance but Still Jumping Further? Negative Association of Free Testosterone With Jumping Performance in Elite Handball Players Following a Preparatory Period.
The present study investigated the effects of a 10-week preparatory training period on biomarkers and jumping performance and associations of changes in biomarkers, load, and jumping performance from the beginning (PRE) to the end of the preparatory period (POST) in elite handball players. Seventeen elite handball players competing in the first Slovenian men's League were recruited. Training, competition and academic loads were reported weekly, while biomarkers and jumping performance were assessed at PRE and POST. At POST, decreased levels of free testosterone (large effect size [ES] = -1.69, < .001) and free testosterone to cortisol ratio [FTCR] (large ES = -.95, = .004) were observed; whereas, better performance on the single leg lateral hop test [SLLH] (large ES = .85, = .007) and single leg triple hop test [SLTH] (large ES = 1.05, = .002) were observed compared to PRE. Furthermore, changes in FTCR correlated with changes in cortisol (high = -.751, = .001), SLLH (moderate = -.603, = .022), and SLTH (moderate = -.643, = .013), while changes in free testosterone correlated with SLTH (moderate = -.645, = .013). High intensity trainings with a saturated competition schedule can result in disturbed anabolic/catabolic hormone ratio observed through FTCR decrease, which could indicate either an optimal state or early exhaustiveness. It seems that SLLH and SLTH are more sensitive to changes in biomarkers than a single leg hop test. Sport professionals may use the results for individualized monitoring of an athlete's health and performance, specifically, as an aid for adjusting training loads accordingly to prevent performance declines and potential injury/illness events.
PubMed: 38941621
DOI: 10.1080/02701367.2024.2353715 -
Blood Jun 2024T-prolymphocytic leukemia (T-PLL) is a mature T-cell neoplasm associated with marked chemotherapy resistance and continued poor clinical outcomes. Current treatments,...
T-prolymphocytic leukemia (T-PLL) is a mature T-cell neoplasm associated with marked chemotherapy resistance and continued poor clinical outcomes. Current treatments, i.e. the CD52-antibody alemtuzumab, offer transient responses, with relapses being almost inevitable without consolidating allogeneic transplantation. Recent more detailed concepts of T-PLL's pathobiology fostered the identification of actionable vulnerabilities: (i) altered epigenetics, (ii) defective DNA damage responses, (iii) aberrant cell-cycle regulation, and (iv) deregulated pro-survival pathways, including TCR and JAK/STAT signaling. To further develop related pre-clinical therapeutic concepts, we studied inhibitors of (H)DACs, BCL2, CDK, MDM2, and clas-sical cytostatics, utilizing (a) single-agent and combinatorial compound testing in 20 well-characterized and molecularly-profiled primary T-PLL (validated by additional 42 cases), and (b) 2 independent murine models (syngeneic transplants and patient-derived xenografts). Overall, the most efficient/selective single-agents and combinations (in vitro and in mice) in-cluded Cladribine, Romidepsin ((H)DAC), Venetoclax (BCL2), and/or Idasanutlin (MDM2). Cladribine sensitivity correlated with expression of its target RRM2. T-PLL cells revealed low overall apoptotic priming with heterogeneous dependencies on BCL2 proteins. In additional 38 T-cell leukemia/lymphoma lines, TP53 mutations were associated with resistance towards MDM2 inhibitors. P53 of T-PLL cells, predominantly in wild-type configuration, was amenable to MDM2 inhibition, which increased its MDM2-unbound fraction. This facilitated P53 activa-tion and down-stream signals (including enhanced accessibility of target-gene chromatin re-gions), in particular synergy with insults by Cladribine. Our data emphasize the therapeutic potential of pharmacologic strategies to reinstate P53-mediated apoptotic responses. The identified efficacies and their synergies provide an informative background on compound and patient selection for trial designs in T-PLL.
PubMed: 38941598
DOI: 10.1182/blood.2023022884 -
JCO Oncology Practice Jun 2024To describe the impact of an inpatient clinical oncology pharmacy technician program.
PURPOSE
To describe the impact of an inpatient clinical oncology pharmacy technician program.
METHODS
A retrospective study was conducted to observe outcomes in patients discharged from the hematology/oncology or bone marrow transplant (BMT) units at Indiana University Health in the year before (April 1, 2016-March 31, 2017) compared with the year after (April 1, 2018-March 31, 2019) the implementation of expanded technician services. The technician performed admission medication histories and ensured access to discharge medications.
RESULTS
There were 1,169 and 1,112 encounters included in the pre- and post-technician cohorts. The median age was lower (54 61 years; < .001), and there was a higher percentage of male patients (62% 52.3%; < .001) in the pre- compared with post-technician cohort. There were a higher percentage of oncology (36.4% 31%; = .007) and no difference in hematology (37.4% 40.2%; = .17) nor BMT encounters (26.3% 28.8%; = .18) in the pre- compared with post-technician cohort. The discharge prescription capture rate increased (42.7% 78.5%; < .001) from the pre- to post-technician cohort, resulting in a 34.2% increase ($314,639.46 in US dollars [USD]-$422,129.20 USD) in retail pharmacy revenue. More admission medication histories were completed by pharmacy staff (64.4% 91.9%; < .001), and there was an increase in the Hospital Consumer Assessment of Healthcare Providers and Systems-derived patient satisfaction results for both hematology/oncology (79% 88%; < .001) and BMT units (77% 84%; = .02) in the pre- compared with post-technician cohort. There was no difference in rates of unplanned readmissions (16.4% 18.2%; = .69) in the pre- compared with post-technician cohort.
CONCLUSION
The overall capture rate of discharge prescriptions, revenue for the retail pharmacy, and patient satisfaction scores significantly increased after the implementation of expanded, inpatient clinical pharmacy technician services.
PubMed: 38941576
DOI: 10.1200/OP.23.00582 -
Neuropsychological Rehabilitation Jun 2024Prevalence rates for both depression and insomnia the first year after stroke are around 30%, significantly impacting the prospects of recovery, rehabilitation, and...
Prevalence rates for both depression and insomnia the first year after stroke are around 30%, significantly impacting the prospects of recovery, rehabilitation, and quality of life. Furthermore, the risk of insomnia and depression becoming chronic is high in the subacute phase post-stroke. This cross-sectional observational study investigated whether insomnia and depression are related in the subacute phase post-stroke, using validated instruments. Sixty-six outpatient stroke survivors participated. Depression was measured using the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) and insomnia severity with the Insomnia Severity Index (ISI). A multiple linear regression analysis was used to examine the association between the dependent variable post-stroke depression and the independent variables insomnia and pre-stroke depression treatment. Results showed that insomnia ( = 0.48, = 4.40, < 0.001) and pre-stroke depression treatment ( = 0.24, = 2.28, = 0.026) were both significant predictors of depression. Participants with more insomnia complaints and participants with pre-stroke depression treatment had more depression symptoms post-stroke. Therefore, it is important to be alert in the subacute phase post-stroke of both, insomnia and depression complaints.
PubMed: 38941450
DOI: 10.1080/09602011.2024.2370072 -
PloS One 2024Many newborn screening programs worldwide have introduced screening for diseases using DNA extracted from dried blood spots (DBS). In Germany, DNA-based assays are...
BACKGROUND
Many newborn screening programs worldwide have introduced screening for diseases using DNA extracted from dried blood spots (DBS). In Germany, DNA-based assays are currently used to screen for severe combined immunodeficiency (SCID), spinal muscular atrophy (SMA), and sickle cell disease (SCD).
METHODS
This study analysed the impact of pre-analytic DNA carry-over in sample preparation on the outcome of DNA-based newborn screening for SCID and SMA and compared the efficacy of rapid extraction versus automated protocols. Additionally, the distribution of T cell receptor excision circles (TREC) on DBS cards, commonly used for routine newborn screening, was determined.
RESULTS
Contaminations from the punching procedure were detected in the SCID and SMA assays in all experimental setups tested. However, a careful evaluation of a cut-off allowed for a clear separation of true positive polymerase chain reaction (PCR) amplifications. Our rapid in-house extraction protocol produced similar amounts compared to automated commercial systems. Therefore, it can be used for reliable DNA-based screening. Additionally, the amount of extracted DNA significantly differs depending on the location of punching within a DBS.
CONCLUSIONS
Newborn screening for SMA and SCID can be performed reliably. It is crucial to ensure that affected newborns are not overlooked. Therefore a carefully consideration of potential contaminating factors and the definition of appropriate cut-offs to minimise the risk of false results are of special concern. It is also important to note that the location of punching plays a pivotal role, and therefore an exact quantification of TREC numbers per μl may not be reliable and should therefore be avoided.
Topics: Humans; Neonatal Screening; Infant, Newborn; Muscular Atrophy, Spinal; Severe Combined Immunodeficiency; DNA; Dried Blood Spot Testing; High-Throughput Screening Assays; Polymerase Chain Reaction
PubMed: 38941330
DOI: 10.1371/journal.pone.0306329 -
Japanese Journal of Clinical Oncology Jun 2024Sarcopenic obesity (SO) affects outcomes in various malignancies. However, its clinical significance in patients undergoing neoadjuvant chemotherapy (NAC) for locally...
BACKGROUND
Sarcopenic obesity (SO) affects outcomes in various malignancies. However, its clinical significance in patients undergoing neoadjuvant chemotherapy (NAC) for locally advanced gastric cancer (LAGC) remains unclear. This study investigated the impact of pre- and post-NAC SO on postoperative morbidity and survival.
METHODS
Data from 207 patients with LAGC, who underwent NAC followed by radical gastrectomy between January 2010 and October 2019, were reviewed. Skeletal muscle mass and visceral fat area were measured pre- and post-NAC using computed tomography to define sarcopenia and obesity, the coexistence of which was defined as SO.
RESULTS
Among the patients, 52 (25.1%) and 38 (18.4%) developed SO before and after NAC, respectively. Both pre- (34.6%) and post- (47.4%) NAC SO were associated with the highest postoperative morbidity rates; however, only post-NAC SO was an independent risk factor for postoperative morbidity [hazard ratio (HR) = 9.550, 95% confidence interval (CI) = 2.818-32.369; P < .001]. Pre-NAC SO was independently associated with poorer 3-year overall [46.2% vs. 61.3%; HR = 1.258 (95% CI = 1.023-1.547); P = .049] and recurrence-free [39.3% vs. 55.4%; HR 1.285 (95% CI 1.045-1.579); P = .017] survival.
CONCLUSIONS
Pre-NAC SO was an independent prognostic factor in patients with LAGC undergoing NAC; post-NAC SO independently predicted postoperative morbidity.
PubMed: 38941323
DOI: 10.1093/jjco/hyae080 -
Journal of Primary Health Care Jun 2024Background Cardiovascular disease is a major health issue for Māori that requires timely and effective first-response care. Māori report culturally unsafe experiences...
Background Cardiovascular disease is a major health issue for Māori that requires timely and effective first-response care. Māori report culturally unsafe experiences in health care, resulting in poor health outcomes. Research in the pre-hospital context is lacking. This study aimed to explore experiences of cultural (un)safety for Māori and their whānau who received acute pre-hospital cardiovascular care from paramedics. Methods Utilising a qualitative descriptive methodology and Kaupapa Māori Research (KMR), in-depth semi-structured interviews were undertaken with 10 Māori patients and/or whānau, and a general inductive approach was used for analysis. Results Three key themes were identified: (1) interpersonal workforce skills, (2) access and service factors and (3) active protection of Māori. Participants described paramedics' clinical knowledge and interpersonal skills, including appropriate communication and ability to connect. Barriers to accessing ambulance services included limited personal and community resources and workforce issues. The impact of heart health on communities and desire for better preventative care highlighted the role of ambulance services in heart health. Conclusion Māori experience culturally unsafe pre-hospital care. Systemic and structural barriers were found to be harmful despite there being fewer reports of interpersonal discrimination than in previous research. Efforts to address workforce representation, resource disparities and cultural safety education (focussing on communication, partnership and connection) are warranted to improve experiences and outcomes for Māori.
Topics: Humans; Native Hawaiian or Other Pacific Islander; Male; Female; New Zealand; Middle Aged; Emergency Medical Services; Qualitative Research; Adult; Cultural Competency; Health Services Accessibility; Allied Health Personnel; Interviews as Topic; Aged; Cardiovascular Diseases; Paramedics; Maori People
PubMed: 38941254
DOI: 10.1071/HC24010 -
Journal of Primary Health Care Jun 2024Introduction From a coronavirus disease (COVID-19) pandemic perspective, Aotearoa New Zealand (NZ) rural residents formed an at-risk population, and disparities between...
He Aroka Urutā. Rural health provider perspectives of the COVID-19 vaccination rollout in rural Aotearoa New Zealand with a focus on Māori and Pasifika communities: a qualitative study.
Introduction From a coronavirus disease (COVID-19) pandemic perspective, Aotearoa New Zealand (NZ) rural residents formed an at-risk population, and disparities between rural and urban COVID-19 vaccination coverage have been found. Aim To gain insight into factors contributing to the urban-rural COVID-19 vaccination disparity by exploring NZ rural health providers' experiences of the vaccine rollout and pandemic response in rural Māori and Pasifika communities. Methods Rural health providers at four sites participated in individual or focus group semi-structured interviews exploring their views of the COVID-19 vaccine rollout. Thematic analysis was undertaken using a framework-guided rapid analysis method. Results Twenty interviews with 42 participants were conducted. Five themes were identified: Pre COVID-19 rural situation, fragile yet resilient; Centrally imposed structures, policies and solutions - urban-centric and Pakehā focused; Multiple logistical challenges - poor/no consideration of rural context in planning stages resulting in wasted resource and time; Taking ownership - rural providers found geographically tailored, culturally anchored and locally driven solutions; Future directions - sustained investment in rural health services, including funding long-term integrated (rather than 'by activity') health services, would ensure success in future vaccine rollouts and other health initiatives for rural communities. Discussion In providing rural health provider perspectives from rural areas serving Māori and Pasifika communities during the NZ COVID-19 vaccine rollout, the importance of the rural context is highlighted. Findings provide a platform on which to build further research regarding models of rural health care to ensure services are designed for rural NZ contexts and capable of meeting the needs of diverse rural communities.
Topics: Humans; New Zealand; COVID-19 Vaccines; COVID-19; Qualitative Research; Native Hawaiian or Other Pacific Islander; Rural Health Services; Rural Population; SARS-CoV-2; Female; Health Personnel; Interviews as Topic; Male; Focus Groups; Healthcare Disparities; Attitude of Health Personnel; Pandemics; Adult; Maori People
PubMed: 38941251
DOI: 10.1071/HC23171