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Journal of Pain and Symptom Management Jun 2024Outpatient palliative care (PC) has strong evidence demonstrating impact across serious illnesses, resulting in growing demand for skilled outpatient PC clinicians....
CONTEXT
Outpatient palliative care (PC) has strong evidence demonstrating impact across serious illnesses, resulting in growing demand for skilled outpatient PC clinicians. However, there is limited literature examining the existing state and quality of outpatient PC education during post-graduate training.
OBJECTIVES
Characterize the current state of outpatient training in United States (US) Hospice and Palliative Medicine (HPM) physician fellowships and elicit perceptions regarding quality of outpatient PC education.
METHODS
A cross-sectional survey of US adult HPM fellowship program directors (PDs) or their designee conducted between March-July 2023.
RESULTS
Of 161 programs, 85 participated (53% response rate) with representation across all US regions. HPM fellows spend a median of 4.8 weeks in outpatient PC compared to 24 weeks inpatient PC and 10.5 weeks in hospice settings. Over half (51%) of fellows saw outpatients from primarily one disease type with limited exposure to patients with other serious illnesses. Across programs, fellows' clinic structure, interdisciplinary team composition, and didactic experiences varied. On a 5-point rating scale, PDs reported significantly lower quality outpatient versus inpatient training (mean rating: 3.58 vs. 4.62, p< 0.001) and perceived fellows as less prepared for independent outpatient practice upon graduation (mean: 4.06 vs. 4.73, p< 0.001).
CONCLUSION
Our survey of US HPM fellowships identified multiple gaps between outpatient and inpatient PC education and training during fellowship and raises concern about the adequacy of outpatient PC training. To prepare the HPM workforce to meet the diverse needs of seriously ill populations and ensure adequate access, outpatient PC training requires reform.
PubMed: 38945458
DOI: 10.1016/j.jpainsymman.2024.06.017 -
The Journal of Pediatrics Jun 2024To examine resource and service use after discharge among infants born extraordinarily preterm in California who attended high-risk infant follow-up (HRIF) clinic by 12...
OBJECTIVE
To examine resource and service use after discharge among infants born extraordinarily preterm in California who attended high-risk infant follow-up (HRIF) clinic by 12 months corrected age (CA).
METHODS
We included infants born 2010-2017 between 22+0/7 and 25+6/7 weeks' gestational age (GA) in the California Perinatal Quality Care Collaborative (CPQCC) and CPQCC-California Children's Services HRIF databases. We evaluated rates of hospitalization, surgeries, medications, equipment, medical service and special service use, and referrals. We examined factors associated with receiving >2 medical services, and >1 special service.
RESULTS
3941 of 5284 infants received a HRIF visit by 12 months CA. Infants born at earlier GAs used more medications, equipment, medical services, and special services and had higher rates of referral to medical and special services at the first HRIF visit. Infants with major morbidity, surgery, caregiver concerns, and mothers with more years of education had higher odds of receiving >2 medical services. Infants with Black maternal race, younger maternal age, female sex, and discharge from lower level NICUs had lower odds of receiving >2 medical services. Infants with more educated mothers, multiple gestation, major morbidity, surgery, caregiver concerns, and discharge from lower level NICUs had increased odds of receiving a special service.
CONCLUSIONS
Infants born extraordinarily preterm have substantial resource use after discharge. High resource utilization was associated with maternal/sociodemographic factors and expected clinical factors. Early functional and service use information is valuable to parents and underscores the need for NICU providers to appropriately prepare and refer families.
PubMed: 38945445
DOI: 10.1016/j.jpeds.2024.114172 -
Implementation and Performance of a Point-of-Care COVID-19 Test Program in 4,000 California Schools.The Journal of Pediatrics Jun 2024To evaluate the feasibility and accuracy of an unprecedented COVID-19 antigen testing program in schools, which required a healthcare provider order, laboratory...
OBJECTIVE
To evaluate the feasibility and accuracy of an unprecedented COVID-19 antigen testing program in schools, which required a healthcare provider order, laboratory director, a Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver, as well as training of school personnel.
STUDY DESIGN
Descriptive report of a point-of-care, school-based antigen testing program in California from 8/1/2021 through 5/30/2022, in which participants grades K-12 self-swabbed and school personnel performed testing. Participants included 944,009 students, personnel, and community members from 4,022 California K-12 schools. Outcomes measured include sensitivity and specificity (with polymerase chain reaction [PCR] as comparator), of the Abbott BinaxNOW™ antigen test, number of tests performed, and active infections identified.
RESULTS
Of 102,022 paired PCR/antigen tests, the overall sensitivity and specificity for the antigen test was 81.2% (95%CI:80.5%-81.8%) and 99.6% (95%CI:99.5%-99.6%), respectively using cycle threshold (Ct) values <30. During January through March 2022, the highest prevalence period, the positive predictive value (PPV) of antigen testing was 94.7% and the negative predictive value was 94.2%. Overall, 4,022 school sites were enrolled and 3,987,840 million antigen tests were performed on 944,009 individuals. A total of 162,927 positive antigen tests were reported in 135,163 individuals (14.3% of persons tested).
CONCLUSIONS
Rapidly implementing a school-based testing program in thousands of schools is feasible. Self-swabbing and testing by school personnel can yield accurate results. On-site COVID-19 testing is no longer necessary in schools, but this model provides a framework for future infectious disease threats.
PubMed: 38945441
DOI: 10.1016/j.jpeds.2024.114178 -
International Journal of Infectious... Jun 2024This study sought to detect and characterize influenza A (IAV) and influenza D (IDV) viruses circulating among commercial birds and shop owners in Pakistan's live bird...
OBJECTIVE
This study sought to detect and characterize influenza A (IAV) and influenza D (IDV) viruses circulating among commercial birds and shop owners in Pakistan's live bird markets.
METHODS
Oropharyngeal swabs (n=600; n=300 pools) collected from poultry and nasopharyngeal swabs (n=240) collected from poultry workers were studied for molecular evidence of IAV and IDV using real-time and conventional RT-PCR protocols.
RESULTS
Nineteen (6.3%) poultry pools were positive for IAV and 73.9% of these were positive for H9N2 subtypes. Two (0.83%) poultry workers had evidence of IAV, and both were also H9N2 subtypes. The poultry and human influenza A-positive specimens all clustered phylogenetically by Sanger and next-generation sequencing with previously detected H9N2 poultry isolates. No field specimens were positive for IDV.
CONCLUSION
H9N2 IAV is likely enzootic in Punjab Province Pakistan's live bird markets and may be colonizing the noses of workers and market visitors. Regular monitoring for avian influenza-associated human illness in Punjab seems to be a needed public measure.
PubMed: 38945434
DOI: 10.1016/j.ijid.2024.107146 -
Acta Tropica Jun 2024Dengue fever is a viral illness, mainly transmitted by Aedes aegypti and Aedes albopictus. With climate change and urbanisation, more urbanised areas are becoming...
Dengue fever is a viral illness, mainly transmitted by Aedes aegypti and Aedes albopictus. With climate change and urbanisation, more urbanised areas are becoming suitable for the survival and reproduction of dengue vector, consequently are becoming suitable for dengue transmission in China. Chongqing, a metropolis in southwestern China, has recently been hit by imported and local dengue fever, experiencing its first local outbreak in 2019. However, the genetic evolution dynamics of dengue viruses and the spatiotemporal patterns of imported and local dengue cases have not yet been elucidated. Hence, this study implemented phylogenetic analyses using genomic data of dengue viruses in 2019 and 2023 and a spatiotemporal analysis of dengue cases collected from 2013 to 2022. We sequenced a total of 15 nucleotide sequences of E genes. The dengue viruses formed separate clusters and were genetically related to those from Guangdong Province, China, and countries in Southeast Asia, including Laos, Thailand, Myanmar and Cambodia. Chongqing experienced a dengue outbreak in 2019 when 168 imported and 1,243 local cases were reported, mainly in September and October. Few cases were reported in 2013-2018, and only six were imported from 2020 to 2022 due to the COVID-19 lockdowns. Our findings suggest that dengue prevention in Chongqing should focus on domestic and overseas population mobility, especially in the Yubei and Wanzhou districts, where airports and railway stations are located, and the period between August and October when dengue outbreaks occur in endemic regions. Moreover, continuous vector monitoring should be implemented, especially during August-October, which would be useful for controlling the Aedes mosquitoes. This study is significant for defining Chongqing's appropriate dengue prevention and control strategies.
PubMed: 38945422
DOI: 10.1016/j.actatropica.2024.107308 -
Infection, Genetics and Evolution :... Jun 2024Chronic leg ulcers are hard to treat and can be a burden, particularly in resource-limited settings where diagnosis is a challenge. Staphylococcus aureus is among the...
BACKGROUND
Chronic leg ulcers are hard to treat and can be a burden, particularly in resource-limited settings where diagnosis is a challenge. Staphylococcus aureus is among the common bacteria isolated from chronic wounds with a great impact on wound healing, particularly in patients with co-morbidities. Antimicrobial resistance genes and virulence factors in Staphylococcus aureus isolates were assessed to support healthcare professionals to make better therapeutic choices, and importantly to curb the development and spread of antibiotic resistance.
METHODS
A cross-sectional study involved both inpatients and outpatients with chronic leg ulcers was conducted from August 2022 to April 2023 in 2 health facilities in Kilimanjaro region in Tanzania. Antimicrobial susceptibility testing was done using the disc diffusion method. Further, whole genome sequencing was performed to study the genotypic characteristics of the isolates.
RESULTS
A total of 92 participants were recruited in which 9 participants were only positive for 10 Staphylococcus aureus isolates upon culture. Five STs among 9 isolates were identified. Most of them belonged to ST8 (44%), with 1 isolate does not belong to any ST. Additionally, 50% of the isolates were methicillin-resistant Staphylococcus aureus (MRSA). All S. aureus isolates had almost similar virulence factors such as hemolysin, proteases and evasions that promote toxin production, protease production and host immune evasion respectively. Moreover, all mecA positive S. aureus isolates were phenotypically susceptible to cefoxitin.
CONCLUSION
Presence of mecA positive S. aureus isolates which are also phenotypically susceptible to cefoxitin implies the possibility of classifying MRSA as MSSA. This may result in the possible emergence of highly cefoxitin - resistant strains in health care and community settings when subsequently exposed to beta-lactam agents. Therefore, combination of whole genome sequencing and conventional methods is important in assessing bacterial resistance and virulence to improve management of patients.
PubMed: 38945421
DOI: 10.1016/j.meegid.2024.105631 -
Biological Psychiatry Jun 2024Fragile X syndrome (FXS) is a genetic condition associated with increased risk for social anxiety and avoidance. Using functional near-infrared spectroscopy (fNIRS), we...
BACKGROUND
Fragile X syndrome (FXS) is a genetic condition associated with increased risk for social anxiety and avoidance. Using functional near-infrared spectroscopy (fNIRS), we previously demonstrated aberrant neural activity responding to faces in young girls with FXS cross-sectionally. Here, we tested the hypothesis that abnormalities in neural activation and sensitization would increase with age in 65 girls with FXS, ages 5-16 years, relative to an age-matched control group of 52 girls who had comparable cognitive function and clinical symptoms.
METHODS
Functional NIRS data were collected at two time points, 2.8±0.6 years apart during a face-processing task. Linear mixed-effects models examined longitudinal neural profiles in girls with FXS and control. Correlational analysis was performed to examine associations between neural sensitization (increasing neural response to repeated stimuli), and clinical ratings.
RESULTS
In girls with FXS, 32 participants had one, and 24 had two fNIRS scans. In controls, 21 had one, and 29 had two fNIRS scans. Brain activations in the right middle and superior frontal gyri were higher in FXS than controls at both time points. Neural sensitization also increased in FXS at a higher rate than controls in the superior frontal gyrus when responding to upright faces. For the FXS group, sensitization in the superior frontal gyrus positively correlated with longitudinal increases in anxiety and social avoidance scores.
CONCLUSION
Girls with FXS show increasingly abnormal neural activation and sensitization responding to faces over time. Aberrant neural sensitization in girls with FXS is associated with longitudinal changes in anxiety and social skills.
PubMed: 38945386
DOI: 10.1016/j.biopsych.2024.06.020 -
The French Journal of Urology Jun 2024Compare scoring systems using Fournier gangrene severity index (FGSI), Uludag Fournier gangrene severity index (UFGSI), Laboratory Risk Indicator for Necrotizing...
INTRODUCTION
Compare scoring systems using Fournier gangrene severity index (FGSI), Uludag Fournier gangrene severity index (UFGSI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), and neutrophil-lymphocyte ratio (NLR) to predict the outcome of patients with Fournier gangrene Materials and Methods: This is a retrospective cohort study that includes FG patients from 2012 to 2021. NLR, FGSI, UFGSI, and LRINEC values were calculated and analyzed. Each scoring system was analyzed using a receiver operating curve (ROC) analysis to determine its sensitivity, specificity, and area under the curve (AUC). Statistical analysis was performed using SPSS version 25.
RESULTS
A total of 158 patients were included in this study. Regarding the mortality outcome, FGSI comprised the highest value of AUC with 80.9, with a sensitivity of 91.7% and specificity of 68.5%. LRINEC comprised the AUC value of 61.1, with 79.2% sensitivity and 64.2% specificity. NLR comprised an AUC value of 63.7, 91.7% of sensitivity, and 98.1% of specificity. In terms of length of stay, LRINEC and NLR were associated as significant predictor.
CONCLUSION
FGSI, UFGSI, and NLR are significant predictors associated with mortality in patients with Fournier gangrene. FGSI and UFGSI comprised the highest sensitivity and specificity value in predicting mortality prognosis. Moreover, this study highlighted the role of NLR and LRINEC as significant predictors for the length of hospitalization. This study shows that FGSI is still a reliable scoring system for predicting mortality in patients with Fournier Gangrene.
PubMed: 38945366
DOI: 10.1016/j.fjurol.2024.102673 -
Contraception Jun 2024To evaluate reasons for non-fulfillment and ongoing contraceptive plans of patients who desired but did not receive inpatient postpartum permanent contraception (PC).
OBJECTIVE
To evaluate reasons for non-fulfillment and ongoing contraceptive plans of patients who desired but did not receive inpatient postpartum permanent contraception (PC).
STUDY DESIGN
Multi-site retrospective cohort study of 1,254 patients with unfulfilled inpatient postpartum PC. We analyzed the reason for PC non-fulfillment, documented contraceptive plan, and method prescription or provision at hospital discharge, six-weeks, and one-year postpartum.
RESULTS
In our cohort, 44.3% of patients with unfulfilled inpatient PC did not receive any highly- or moderately-effective contraception within one year postpartum.
CONCLUSIONS
Removing barriers to PC fulfillment as well as contraceptive counseling that acknowledges these barriers is imperative.
PubMed: 38945351
DOI: 10.1016/j.contraception.2024.110533 -
Annals of Epidemiology Jun 2024Reliance on null hypothesis significance testing often leads to misinterpretation of research results. Common misinterpretations include that a statistically...
PURPOSE
Reliance on null hypothesis significance testing often leads to misinterpretation of research results. Common misinterpretations include that a statistically nonsignificant difference (p≥0.05) implies no difference between groups, and that a statistically significant finding (p<0.05) is unbiased and clinically important. We aimed to develop a tool - the Conclusion Generator - to mitigate these misconceptions.
METHODS
We reviewed the content of the Conclusion Generator and validated its output using published and simulated data.
RESULTS
The Conclusion Generator is a free online application designed to generate conclusions for scientific papers based on the values and clinical interpretation of the point estimate and confidence interval. Both relative and absolute measures of effect are supported. It offers two modes for interpretation: (1) Statistical mode provides an accurate statistical interpretation of results, with an optional specification of superiority and noninferiority bounds; (2) Clinical mode evaluates the clinical importance of the point estimate and confidence limits as specified by the user. Both modes assume no uncontrolled biases. Users must specify the number of decimals, the direction of a beneficial effect (e.g., relative risk <1 vs. >1), and the level of detail (concise vs. elaborated) for the output. The validation confirmed the Conclusion Generator's capability to interpret research results, considering random error and clinical relevance, while avoiding common misinterpretations associated with null hypothesis significance testing.
CONCLUSIONS
The Conclusion Generator facilitates an appropriate interpretation of research results by emphasizing estimation and clinical relevance over hypothesis testing.
PubMed: 38945314
DOI: 10.1016/j.annepidem.2024.06.008