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Pakistan Journal of Medical Sciences Jul 2024Several studies have investigated the effectiveness of preoperative or perioperative pulmonary rehabilitation in thoracic surgery patients, but the results are... (Review)
Review
Effectiveness of preoperative and perioperative pulmonary rehabilitation nursing program for the management of patients undergoing thoracic surgery: A systematic review and meta-analysis.
BACKGROUND & OBJECTIVE
Several studies have investigated the effectiveness of preoperative or perioperative pulmonary rehabilitation in thoracic surgery patients, but the results are inconsistent and inconclusive. This study attempts to summarize the existing data on the effect of the preoperative and perioperative pulmonary rehabilitation nursing program for the management of patients undergoing thoracic surgery.
METHODS
Systematic search was done in PubMed Central, SCOPUS, EMBASE, MEDLINE, Google Scholar, and ScienceDirect for papers published until December 2022 and reporting data of postoperative complications and pulmonary health status in patients undergoing thoracic surgery and receiving preoperative or perioperative pulmonary rehabilitation nursing intervention or standard care. Meta-analysis was done by random-effects model and pooled standardised mean differences (SMD) or odds ratios (OR) along with 95% confidence intervals (CIs) were reported.
RESULTS
Eighteen studies were included and analysed. Pooled SMD was 0.44 (95%CI: -0.21 to 1.08) for forced expiratory volume (FEV-1), -0.34 (95%CI: -0.94 to 0.26) for peak expiratory flow (PEF), 0.61 (95%CI: -0.60 to 1.81) for forced vital capacity (FVC), 0.42 (95%CI: -0.13 to 0.98) for diffusing capacity of carbon monoxide (DLCO). Pooled SMD for length of hospital stay was -0.64 (95%CI: -1.09 to -0.19). Pooled OR was 0.87 [95%CI: 0.32 to 2.37] for all-cause mortality, 0.35 [95%CI: 0.25 to 0.50] for postoperative pulmonary complications, 0.98 [95%CI: 0.45 to 2.12] for respiratory failure, 0.52 [95%CI: 0.38 to 0.78] for pneumonia and 0.50 [95%CI: 0.33 to 0.76] for atelectasis.
CONCLUSION
Perioperative pulmonary rehabilitation nursing program is effective in reducing the postoperative lung complications and shortening the length of hospital stay in patients undergoing thoracic surgery.
PubMed: 38952505
DOI: 10.12669/pjms.40.6.9259 -
Pakistan Journal of Medical Sciences Jul 2024To know about the trends in the management of neck of femur fractures with arthroplasty in patients ≥ 50 years.
OBJECTIVE
To know about the trends in the management of neck of femur fractures with arthroplasty in patients ≥ 50 years.
METHODS
It is a retrospective cross-sectional study with data collection from Hospital Management Information System from 1 January 2020 to 31 July 2023. SPSS version 25 was used for data analysis. Mean & standard deviation was reported for quantitative variable & frequency and proportion were reported for qualitative variables. The cross- tabulations were performed to evaluate the association between the variables.
RESULTS
Total number of patients in this study was 305. Mean age was 67.80 ± 10.5 SD. Male to female ratio was 150:155. Co-morbidities were found in 126 patients. The surgical options used were Austin Moore prosthesis (64), Cemented Bipolar (36), Hybrid Total Hip Replacement (7), Non-cemented Total Hip Replacement (86), Cemented Total Hip Replacement (32), Uncemented Bipolar (71). Garden Type-2 fracture was noted in 33 patients, Type-3 in 170 patients and Type-4 in 87 patients. Cemented stem was used in 74 patients while 222 patients had non-cemented stem.
CONCLUSION
One quarter of the patients had cemented stem implanted compared to three quarter of the patients who had non-cemented stem.
PubMed: 38952490
DOI: 10.12669/pjms.40.6.9135 -
Immuno-oncology Technology Jun 2024Immune-related adverse events (IRAEs) during therapy with immune checkpoint inhibitors (ICIs) are common, and their management sometimes requires glucocorticoids (GCs)....
Effect of glucocorticoids for the management of immune-related adverse events on outcome in melanoma patients treated with immunotherapy-a retrospective and biomarker study.
BACKGROUND
Immune-related adverse events (IRAEs) during therapy with immune checkpoint inhibitors (ICIs) are common, and their management sometimes requires glucocorticoids (GCs). Predictors for development of IRAEs and data about the impact of GCs on clinical outcome are missing. We evaluated the impact of GCs to treat IRAEs on clinical outcome, and plasmatic inflammatory proteins as predictors for IRAEs.
PATIENTS AND METHODS
Patients with melanoma ( = 98) treated with ICIs at Karolinska University Hospital were included. Clinical information and data regarding prescription of systemic GCs were collected. Baseline plasma samples ( = 57) were analyzed for expression of 92 inflammatory proteins.
RESULTS
Forty-four patients developed at least one IRAE requiring systemic GCs and the most common was hypocortisolemia ( = 11). A median overall survival of 72.8 months for patients developing IRAEs requiring GCs, 17.7 months for those who did not, and 1.4 months for individuals receiving GCs at baseline was observed in Kaplan-Meier curves ( = 0.001). In immortal time bias adjusted analysis, patients receiving steroids to treat IRAE survived slightly longer, even though this time trend was not statistically significant. The median overall survival was 29 months for those treated with GCs within 60 days after ICIs start and was not reached for patients receiving GCs later. The number of ICI cycles was higher in subjects receiving GCs after 60 days ( = 0.0053). Hypocortisolemia occurred mainly in males (10/11) and correlated with favorable outcome. Male patients with hypocortisolemia had lower expression of interleukin 8, transforming growth factor-α, and fibroblast growth factor 5 and higher expression of Delta/Notch-like epidermal growth factor-related receptor.
CONCLUSIONS
GCs may be used to treat IRAEs without major concern. GCs early during ICIs may, however, impact clinical outcome negatively. The prognostic value of hypocortisolemia and inflammation proteins as biomarkers should be further investigated.
PubMed: 38952418
DOI: 10.1016/j.iotech.2024.100713 -
Molecular Imaging 2024To investigate the performance of diffusion-tensor imaging (DTI) and hydrogen proton magnetic resonance spectroscopy (H-MRS) parameters in predicting the...
OBJECTIVE
To investigate the performance of diffusion-tensor imaging (DTI) and hydrogen proton magnetic resonance spectroscopy (H-MRS) parameters in predicting the immunohistochemistry (IHC) biomarkers of glioma.
METHODS
Patients with glioma confirmed by pathology from March 2015 to September 2019 were analyzed, the preoperative DTI and H-MRS images were collected, apparent diffusion coefficient (ADC) and fractional anisotropy (FA), in the lesion area were measured, the relative values relative ADC (rADC) and relative FA (rFA) were obtained by the ratio of them in the lesion area to the contralateral normal area. The peak of each metabolite in the lesion area of H-MRS image: N-acetylaspartate (NAA), choline (Cho), and creatine (Cr), and metabolite ratio: NAA/Cho, NAA/(Cho + Cr) were selected and calculated. The preoperative IHC data were collected including CD34, Ki-67, p53, S-100, syn, vimentin, NeuN, Nestin, and glial fibrillary acidic protein.
RESULTS
One predicting parameter of DTI was screened, the rADC of the Ki-67 positive group was lower than that of the negative group. Two parameters of H-MRS were found to have significant reference values for glioma grades, the NAA and Cr decreased as the grade of glioma increased, moreover, Ki-67 Li was negatively correlated with NAA and Cr.
CONCLUSION
NAA and Cr have potential application value in predicting glioma grades and tumor proliferation activity. Only rADC has predictive value for Ki-67 expression among DTI parameters.
Topics: Humans; Glioma; Male; Female; Middle Aged; Adult; Immunohistochemistry; Brain Neoplasms; Diffusion Tensor Imaging; Magnetic Resonance Imaging; Aged; Proton Magnetic Resonance Spectroscopy; Young Adult
PubMed: 38952400
DOI: 10.1177/15353508241261583 -
Heliyon Jun 2024Thermal spraying (TS) is one of the main processes for obtaining surfaces with the desired protective properties in various industrial applications. TS is an...
Thermal spraying (TS) is one of the main processes for obtaining surfaces with the desired protective properties in various industrial applications. TS is an energy-intensive treatment required to heat the application material and consumes different resources. To assess the environmental impact of TS, it becomes necessary to integrate an approach that jointly analyses and evaluates the economic and environmental variables influencing the system. The concept of eco-efficiency (EE) added to the TS process allows for assessing the environmental and economic condition through the survey and application of eco-indicators. The lack of an EE evaluation model for TS processes was identified based on literature searches. Thus, the overall objective of this work is to propose a conceptual model to evaluate the EE of TS treatment, selecting environmental and economic indicators considered more impactful in the process. The model developed consists of three main steps: (i) the input and output indicators (environmental and economic) are identified by applying the Analytic Hierarchy Process (AHP) method; (ii) the structure to be employed in the model is defined; and (iii) the Data Envelopment Analysis (DEA) model is applied to define the EE evaluation form. The proposed model consists of clear and easy-to-follow steps for evaluating the EE of spraying processes, filling the gap found in the literature. The use of DEA allowed the integration of the environmental and economic indicators obtained from the TS processes to generate important insights for evaluating EE. The results prove the model's effectiveness in identifying the EE results for each analysed unit of the TS process. The model has provided an evaluation consistent with the existing studies, and the EE scores were assessed according to twenty-one decision-making units (DMUs) allowing the identification of the most eco-efficient DMUs concerning TS processes.
PubMed: 38952377
DOI: 10.1016/j.heliyon.2024.e32414 -
Heliyon Jun 2024This study aims to analyze the application of the RBL-STEM learning model in improving students' financial literacy to control their consumptive behavior. The method...
This study aims to analyze the application of the RBL-STEM learning model in improving students' financial literacy to control their consumptive behavior. The method used in this study combines qualitative and quantitative methods by involving 110 students of Riau University. The data of this study were analyzed using SEM PLS on nine Hypotheses that link the application of the RBL-STEM model, student literacy, and student consumptive behavior. The results showed that one hypothesis was rejected, namely the relationship between Risk management and consumptive behavior. The results of the outer model show that each indicator has a composite reliability (CR) value of >0.7 and an average variance extracted (AVE) value of >0.5. It concludes that the outer model used in this study is good. Based on the analysis results, in general, the application of the RBL-STEM learning model has a significant influence on increasing student financial literacy, which has an impact on controlling student consumptive behavior.
PubMed: 38952366
DOI: 10.1016/j.heliyon.2024.e32382 -
Heliyon Jun 2024Population growth and climate change challenge our food and farming systems and provide arguments for an increased intensification of agriculture. Organic farming has...
Population growth and climate change challenge our food and farming systems and provide arguments for an increased intensification of agriculture. Organic farming has been seen as a promising option due to its eco-friendly approaches during production. However, weeds are regarded as the major hindrance to effective crop production which varies depending on the type of crop and spacing. Their presence leads to reduced yield, increase in harvest cost and lower the qualities of some produce. Thus, weed management is a key priority for successful crop production. Therefore, we conducted a meta-analysis from published studies to quantify possible differences on weed density, diversity and evenness in organic and conventional farming systems and best intervention for weed management in organic farming system. Data included were obtained from 32 studies where 31 studies with 410 observations were obtained for weed density, 15 studies with 168 observations for diversity, and 5 studies with 104 observations for evenness. Standard deviation of mean was obtained from the studies, log transformed using natural logarithms and the effect size pooled using standardized mean difference (SMD). Publication bias was determined through funnel plot. Results showed that organic farming has significant higher weed density , diversity , and evenness compared to conventional farming. Despite so, diversified crop rotation has been proved to reduce weed density in organic farming by up to 49 % while maize-bean intercropping decrease densities of ssp, ssp and C ssp compared with monocropping. Use of mulch after one hand weeding was found to control up to 98 % of weeds and use of cover crop between 24 % and 85 % depending on the type of the cover crop. The study results show that organic farming encourages high weed density, diversity and evenness but use of the integrated approaches can help to maintain weed density at a manageable level.
PubMed: 38952364
DOI: 10.1016/j.heliyon.2024.e32761 -
Journal of Korean Medical Science Jul 2024The increasing number of vaccines and the complexity of immunization programs, along with continuous changes in the epidemiology of infectious diseases, necessitate a...
BACKGROUND
The increasing number of vaccines and the complexity of immunization programs, along with continuous changes in the epidemiology of infectious diseases, necessitate a systematic approach to vaccine effectiveness (VE) evaluation. This study presents a preliminary survey to establish a VE evaluation framework in Korea, focusing on the National Immunization Program.
METHODS
Experts' opinions were collected through a two-round online survey targeting key stakeholders. The first round consisted of two multiple-choice questions and two open-ended questions. The second round was a quantitative survey with 17 questionnaires based on five domains derived by analyzing the results of the first-round survey.
RESULTS
The results emphasize the necessity and urgency of a government-led VE evaluation system and the establishment of a multidisciplinary evaluation organization. Key considerations include personnel, budget, data integration, legal standards, and surveillance system enhancements.
CONCLUSION
These findings provide valuable insights for policymakers, emphasizing the need for collaboration, financial support, and robust data management in developing evidence-based vaccination policies.
Topics: Humans; Immunization Programs; Republic of Korea; Surveys and Questionnaires; Vaccines; Vaccination; Health Policy
PubMed: 38952346
DOI: 10.3346/jkms.2024.39.e193 -
Journal of Korean Medical Science Jul 2024Balancing parenting and work life poses challenges for women with children, potentially making them vulnerable to depression owing to their dual responsibilities....
BACKGROUND
Balancing parenting and work life poses challenges for women with children, potentially making them vulnerable to depression owing to their dual responsibilities. Investigating working mothers' mental health status is important on both the individual and societal levels. This study aimed to explore the relationship between economic activity participation and depressive symptoms among working mothers.
METHODS
This study was a cross-sectional study and used data from the Korea National Health and Nutrition Examination Survey collected in 2014, 2016, 2018, and 2020. The participants in the study were women aged 19 to 50 who were residing with their children. In the total, 3,151 participants were used in the analysis. The independent variable was economic activity, categorized into two groups: 1) economically active and 2) economically inactive. The dependent variable was the depressive symptoms, categorized as present for a Patient Health Questionnaire-9 score of ≥ 10 and absent for a score < 10. Multiple logistic regression analysis was performed to assess the association between economic activity and depressive symptoms, and sensitivity analyses were performed based on the severity of depressive symptoms.
RESULTS
Among women with children, economically active women had reduced odds ratio of depressive symptoms compared with economically inactive women (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.36-0.80). In additional analysis, women working as wage earners had the lowest odds of depressive symptoms (OR, 0.43; 95% CI, 0.28-0.66). Women working an average of 40 hours or less per week were least likely to have depressive symptoms (OR, 0.42; 95% CI, 0.25-0.69).
CONCLUSION
Economic activity is significantly associated with depressive symptoms among women with children. Environmental support and policy approaches are needed to ensure that women remain economically active after childbirth.
Topics: Humans; Female; Depression; Adult; Cross-Sectional Studies; Republic of Korea; Mothers; Parenting; Young Adult; Middle Aged; Nutrition Surveys; Odds Ratio; Logistic Models; Child; Women, Working
PubMed: 38952345
DOI: 10.3346/jkms.2024.39.e192 -
Diabetes, Obesity & Metabolism Jul 2024Choosing the initial treatment for type 2 diabetes (T2D) is pivotal, requiring consideration of solid clinical evidence and patient characteristics. Despite metformin's...
AIM
Choosing the initial treatment for type 2 diabetes (T2D) is pivotal, requiring consideration of solid clinical evidence and patient characteristics. Despite metformin's historical preference, its efficacy in preventing cerebrovascular events lacked empirical validation. This study aimed to evaluate the associations between first-line monotherapy (metformin or non-metformin antidiabetic medications) and cerebrovascular complications in patients with T2D without diabetic complications.
METHODS
We analysed 9090 patients with T2D without complications who were prescribed either metformin or non-metformin medications as initial therapy. Propensity score matching ensured group comparability. Cox regression analyses, stratified by initial metformin use, assessed cerebrovascular disease risk, adjusting for multiple covariates and using competing risk analysis. Metformin exposure was measured using cumulative defined daily doses.
RESULTS
Metformin users had a significantly lower crude incidence of cerebrovascular diseases compared with non-users (p < .0001). Adjusted hazard ratios (aHRs) consistently showed an association between metformin use and a lower risk of overall cerebrovascular diseases (aHRs: 0.67-0.69) and severe events (aHRs: 0.67-0.69). The association with reduced risk of mild cerebrovascular diseases was significant across all models (aHRs: 0.73-0.74). Higher cumulative defined daily doses of metformin correlated with reduced cerebrovascular risk (incidence rate ratio: 0.62-0.94, p < .0001), indicating a dose-dependent effect.
CONCLUSION
Metformin monotherapy is associated with a reduced risk of cerebrovascular diseases in early-stage T2D, highlighting its dose-dependent efficacy. However, the observed benefits might also be influenced by baseline differences and the increased risks associated with other medications, such as sulphonylureas. These findings emphasize the need for personalized diabetes management, particularly in mitigating cerebrovascular risk in early T2D stages.
PubMed: 38952343
DOI: 10.1111/dom.15739