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Journal of Clinical Sleep Medicine :... Jul 2024Behavioral sleep medicine (BSM) is a subspecialty that combines behavioral psychology and sleep medicine specialties. The objective of this study was to analyze referral...
STUDY OBJECTIVES
Behavioral sleep medicine (BSM) is a subspecialty that combines behavioral psychology and sleep medicine specialties. The objective of this study was to analyze referral patterns to a BSM clinic. The three specific aims were: (1) describe factors that predict referral acceptance, (2) identify barriers to attending initial appointment, and (3) describe variables associated with the number of visits attended.
METHODS
Retrospective chart reviews were conducted as part of a quality improvement project by this study team's clinical setting. Adults over 21 years of age who were referred to a behavioral sleep medicine clinic in an urban Midwestern academic healthcare system between 2014-2019 were included in this study.
RESULTS
Sleep medicine was the main referral source for BSM patients (74.2%), followed by internal medicine (9.3%) and neurology/psychiatry (7.3%). Thirty-eight percent of patients did not schedule an appointment after a referral for BSM was initiated. Younger age, longer distance from clinic, commercial insurance and out of network insurance were all significantly greater for non-schedulers. Eighty-three percent of patients did attend the initial intake session with BSM providers. Older age was associated with lower likelihood of not attending scheduled BSM appointments.
CONCLUSIONS
Patient characteristics of older age, closer distance from clinic, and in network insurance coverage were found to significantly increase the likelihood of BSM scheduling, while younger age, Black race and not getting a primary sleep disorder diagnosis (versus a diagnosis of Insomnia Disorder) and shorter days from referral to appointment were associated with an increased likelihood of not attending the scheduled BSM treatment engagement.
PubMed: 38958056
DOI: 10.5664/jcsm.11252 -
AIDS Patient Care and STDs Jul 2024To understand the global dual HIV infection (DI) profiles comprehensively, the databases Cochrane Library, Embase, PubMed, and Web of Science were the data sources up to... (Review)
Review
To understand the global dual HIV infection (DI) profiles comprehensively, the databases Cochrane Library, Embase, PubMed, and Web of Science were the data sources up to March 31, 2024 (PROSPERO: CRD42023388328). Stata and R-language software were used to analyze the extracted data. Publication bias was assessed using Egger's test. Sensitivity analysis was conducted to evaluate the stability of the combined effect values. Data from 17 eligible studies across four continents (Africa, Asia, Europe, and North America) with 1,475 subjects were used. The combined dual infection rate (DIR) was 10.47% (95% CI: 7.11%-14.38%) without a time trend ( = 0.105). The DIRs of target population groups differed significantly, with FSWs having the highest DIR (15.14%), followed by general population (12.08%), MSM (11.84%), and DUs (9.76%). The subtype profiles of 122 patients with dual infection were extracted, and the results showed that intrasubtype infections were predominant in coinfection (16/22, 72.73%) and superinfection (68/100, 68.00%) groups, with the subtype pattern B and B accounts for the largest proportion. The global dual infection rate may be underestimated, even though the data fluctuated around 10% and showed no time trend. The occurrence of DI indicated that individuals still do not acquire sufficient resistance to HIV even after primary infection, which could potentially compromise the patient's treatment effect and lead to the emergence of new subtypes, posing a significant challenge to HIV prevention, control, and treatment, suggesting that behavioral counseling and health education for all HIV-infected individuals are still crucial during the antiviral therapy.
PubMed: 38957963
DOI: 10.1089/apc.2024.0100 -
Internal Medicine Journal Jul 2024Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are novel agents for heart failure (HF) and are now recommended in guidelines. Understanding general physicians'...
BACKGROUND
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are novel agents for heart failure (HF) and are now recommended in guidelines. Understanding general physicians' perspectives can help to optimise utilisation of this new medication.
AIM
To understand the clinical concerns and barriers from general physicians about prescribing SGLT2is in a general medicine cohort.
METHODS
A questionnaire exploring clinicians' experience, comfort level and barriers to prescribing SGLT2is in patients with HF, incorporating two clinical scenarios, was disseminated to Internal Medicine Society of Australia and New Zealand members over a 2-month period.
RESULTS
Ninety-eight participants responded to the questionnaire (10.8% response rate). Most respondents (66.3%) were senior medical staff. Most participants worked in metropolitan settings (64.3%) and in public hospital settings (83.7%). For HF with reduced ejection fraction, 23.5% of participants reported prescribing SGLT2is frequently (defined as prescribing SGLT2is frequently over 75% of occasions). For HF with preserved ejection fraction, 57.1% of participants reported prescribing SGLT2is less than 25% of the time. Almost half of the participants (44%) expressed a high level of familiarity with therapeutic knowledge of SGLT2is, while 47% indicated high familiarity with potential side effects. Patient complexity, cost of medications and discontinuity of care were identified as important barriers. Euglycemic diabetic ketoacidosis was the side effect that caused the most hesitancy to prescribe SGLT2is in 48% of the respondents.
CONCLUSION
General physicians in Australia and Aotearoa New Zealand are familiar with the therapeutic knowledge and side effects of SGLT2is. Patient complexity, medication cost and discontinuity of care were significant barriers to the use of SGLT2is for HF among general physicians.
PubMed: 38957943
DOI: 10.1111/imj.16440 -
Nursing Open Jul 2024To explore the assumptions and values that influence nursing health assessment practices among registered general nurses in general medical and surgical wards.
AIM
To explore the assumptions and values that influence nursing health assessment practices among registered general nurses in general medical and surgical wards.
DESIGN
The study was designed as a focused ethnography.
METHODS
A semi-structured interview guide was used to explore prevailing nursing health assessment practices of 13 registered general nurses in an attempt to explore the assumptions and values influencing health assessment practices in the study setting. Data were analysed inductively using an interpretive qualitative content analysis method.
RESULTS
Nursing health assessment practices, and underlying assumptions and values were underpinned by a central theme of a culture of low expectation relating to nursing health assessment. The culture of low expectation was highlighted in five themes: (1) Unsystematic Assessment of Health Status, (2) Purpose of Nursing Health Assessment, (3) The Role of Nursing Educational and Regulatory Institutions, (4) Ward Ethos and (5) The Role of Organizational and Ward Leadership.
IMPLICATION
The adoption of a holistic nursing health assessment framework with a clearly defined purpose of aiding nursing diagnoses can guide patient-centred care delivery and facilitate early recognition of physiological deterioration.
PATIENT OR PUBLIC CONTRIBUTION
Thirteen registered general nurses were interviewed, and the initial findings returned to them for validation.
CONCLUSION
The potential contribution of nursing health assessment to nursing practice and patient outcomes may not be fully realized if nursing health assessment is not situated within a holistic health assessment model with a clearly defined purpose for nursing practice.
Topics: Humans; Anthropology, Cultural; Qualitative Research; Tertiary Care Centers; Nursing Assessment; Female; Adult; Nursing Staff, Hospital; Male; Interviews as Topic; Nurses; Attitude of Health Personnel; Middle Aged
PubMed: 38957916
DOI: 10.1002/nop2.2237 -
Health Science Reports Jul 2024Stroke is a prominent cause of long-term adult impairment globally and a significant global health issue. Only 14% of stroke survivors achieve full recovery, while 25%... (Review)
Review
BACKGROUND AND AIMS
Stroke is a prominent cause of long-term adult impairment globally and a significant global health issue. Only 14% of stroke survivors achieve full recovery, while 25% to 50% require varying degrees of support, and over half become dependent. The aftermath of a stroke brings profound changes to an individual's life, with early choices significantly impacting their quality of life. This review aims to establish the efficacy of neuroimaging data in predicting long-term outcomes and recovery rates following a stroke.
METHODS
A scientific literature search was conducted using the Centre of Reviews and Dissemination (CRD) criteria and PRISMA guidelines for a combined meta-narrative and systematic quantitative review. The methodology involved a structured search in databases like PubMed and The Cochrane Library, following inclusion and exclusion criteria to identify relevant studies on neuroimaging biomarkers for stroke outcome prediction. Data collection utilized the Microsoft Edge Zotero plugin, with quality appraisal conducted via the CASP checklist. Studies published from 2010 to 2024, including observational, randomized control trials, case reports, and clinical trials. Non-English and incomplete studies were excluded, resulting in the identification of 11 pertinent articles. Data extraction emphasized study methodologies, stroke conditions, clinical parameters, and biomarkers, aiming to provide a thorough literature overview and evaluate the significance of neuroimaging biomarkers in predicting stroke recovery outcomes.
RESULTS
The results of this systematic review indicate that integrating advanced neuroimaging methods with highly successful reperfusion therapies following a stroke facilitates the diagnosis of the condition and assists in improving neurological impairments resulting from stroke. These measures reduce the possibility of death and improve the treatment provided to stroke patients.
CONCLUSION
These findings highlight the crucial role of neuroimaging in advancing our understanding of post-stroke outcomes and improving patient care.
PubMed: 38957864
DOI: 10.1002/hsr2.2221 -
CHEST Critical Care Jun 2024Psychological distress symptoms are present and persistent among many patients who survive a critical illness like COVID-19.
BACKGROUND
Psychological distress symptoms are present and persistent among many patients who survive a critical illness like COVID-19.
RESEARCH QUESTION
Could a self-directed mobile app-delivered mindfulness intervention be feasibly and rapidly implemented within a clinical trials network to reduce distress symptoms?
STUDY DESIGN AND METHODS
A randomized clinical trial was conducted between January 2021 and May 2022 at 29 US sites and included survivors of hospitalization due to COVID-19-related illness with elevated symptoms of depression at discharge. Participants were randomized to intervention or usual care control. The intervention consisted of four themed weeks of daily audio, video, and text content. All study procedures were virtual. The primary outcome was depression symptoms assessed with the Patient Health Questionnaire 9 at 3 months. Secondary outcomes included anxiety (Generalized Anxiety Disorder 7-item scale), quality of life (EQ-5D), and adherence. We used general linear models to estimate treatment arm differences in outcomes over time.
RESULTS
Among 56 randomized participants (mean age ± SD, 51.0 ± 13.2 years; 38 female [67.9%]; 14 Black participants [25%]), 45 (intervention: n = 23 [79%]; control: n = 22 [81%]) were retained at 6 months. There was no difference in mean improvement between intervention and control participants at 3 months in Patient Health Questionnaire 9 (-0.5 vs 0.1), Generalized Anxiety Disorder 7-item scale (-0.3 vs 0.1), or EQ-5D (-0.03 vs 0.02) scores, respectively; 6-month results were similar. Only 15 participants (51.7%) initiated the intervention, whereas the mean number ± SD of the 56 prescribed intervention activities completed was 12.0 ± 15.2. Regulatory approvals delayed trial initiation by nearly a year.
INTERPRETATION
Among survivors of COVID-19 hospitalization with elevated psychological distress symptoms, a self-directed mobile app-based mindfulness intervention had poor adherence. Future psychological distress interventions mobilized at broad scale should focus efforts on patient engagement and regulatory simplification to enhance success.
TRIAL REGISTRATION
ClinicalTrials.gov; No.: NCT04581200; URL: www.clinicaltrials.gov.
PubMed: 38957856
DOI: 10.1016/j.chstcc.2024.100063 -
CHEST Critical Care Jun 2024Nearly one-quarter of all Americans die in the ICU. Many of their deaths are anticipated and occur following the withdrawal of mechanical ventilation (WMV). However,...
BACKGROUND
Nearly one-quarter of all Americans die in the ICU. Many of their deaths are anticipated and occur following the withdrawal of mechanical ventilation (WMV). However, there are few data on which to base best practices for interdisciplinary ICU teams to conduct WMV.
RESEARCH QUESTION
What are the perceptions of current WMV practices among ICU clinicians, and what are their opinions of processes that might improve the practice of WMV at end of life in the ICU?
STUDY DESIGN AND METHODS
This prospective two-center observational study conducted in Boston, Massachusetts, the Observational Study of the Withdrawal of Mechanical Ventilation (OBSERVE-WMV) was designed to better understand the perspectives of clinicians and experience of patients undergoing WMV. This report focuses on analyses of qualitative data obtained from in-person surveys administered to the ICU clinicians (nurses, respiratory therapists, and physicians) caring for these patients. Surveys assessed a broad range of clinician perspectives on planning, as well as the key processes required for WMV. This analysis used independent open, inductive coding of responses to open-ended questions. Initial codes were reconciled iteratively and then organized and interpreted using a thematic analysis approach. Opinions were assessed on how WMV could be improved for individual patients and the ICU as a whole.
RESULTS
Among 456 eligible clinicians, 312 in-person surveys were completed by clinicians caring for 152 patients who underwent WMV. Qualitative analyses identified two main themes characterizing high-quality WMV processes: (1) good communication (eg, mutual understanding of family preferences) between the ICU team and family; and (2) medical management (eg, planning, availability of ICU team) that minimizes patient distress. Team member support was identified as an essential process component in both themes.
INTERPRETATION
Clinician perceptions of the appropriateness or success of WMV prioritize the quality of team and family communication and patient symptom management. Both are modifiable targets of interventions aimed at optimizing overall WMV.
PubMed: 38957855
DOI: 10.1016/j.chstcc.2024.100051 -
Ghana Medical Journal Dec 2023To determine the prevalence and severity of anaemia and assess the relationship between dietary lifestyle, hypoalbuminaemia, and anaemia of older persons.
OBJECTIVES
To determine the prevalence and severity of anaemia and assess the relationship between dietary lifestyle, hypoalbuminaemia, and anaemia of older persons.
DESIGN
A cross-sectional hospital-based study.
SETTING
This study was conducted in the General Outpatient Clinic, the primary care unit of Aminu Kano Teaching Hospital in Kano, Nigeria.
PARTICIPANTS
A total of 378 patients aged ≥ 60 years who presented to the General Out-patient Clinic.
MAIN OUTCOME MEASURES
Prevalence and severity of anaemia, relationship between anaemia and hypoalbuminaemia, and dietary lifestyle of the participants.
RESULTS
A total of 348 respondents completed the study. The mean age of respondents was 67.83 ±7.53 years, with female (60.9%) predominance. The prevalence of anaemia and hypoalbuminaemia were 42.2% and 17.8%, respectively. Hypoalbuminaemia (β=0.335, 95%CI=0.131-0.229, <0.001), long duration of comorbidities (β= -0.179, 95%CI= -0.165-0.047, <0.001), one full meal/day (β=0.130, 95%CI=0.224-1.879, =0.013), and low monthly income (β=0.122, 95%CI=0.179-1.543, =0.026) were the predictors of anaemia among the older persons in this study.
CONCLUSION
This study revealed a high prevalence of anaemia among older adults. The identified predictors, such as hypoalbuminaemia, long duration of comorbidities, reduced food intake and low monthly income, will be useful in developing guidelines and strategies for managing the condition in primary care settings and other similar sites.
FUNDING
None declared.
Topics: Humans; Female; Nigeria; Male; Aged; Hypoalbuminemia; Cross-Sectional Studies; Middle Aged; Anemia; Prevalence; Primary Health Care; Life Style; Diet; Aged, 80 and over
PubMed: 38957852
DOI: 10.4314/gmj.v57i4.7 -
Ghana Medical Journal Dec 2023To compare clinical characteristics of COVID-19 among vaccinated and unvaccinated patients in a major treatment facility in Ghana. (Comparative Study)
Comparative Study
OBJECTIVES
To compare clinical characteristics of COVID-19 among vaccinated and unvaccinated patients in a major treatment facility in Ghana.
DESIGN
A retrospective study drawing on data from COVID-19 patients' records visiting the facility from March 2021 to December 2021.
SETTING
Ghana Infectious Disease Centre, Ga East Municipality, Greater Accra Region, Ghana.
PARTICIPANTS
In-patients and outpatients who reported to the facility from 1st March 2021 to December 2021 were included in the study, and patients with missing data on vaccination were excluded.
OUTCOME MEASURES
underlying conditions, symptoms, case management information, hospital service rendered (OPD, HDU or ICU), length of hospital stay, treatment outcome.
RESULTS
The study included 775 patient records comprising 615 OPD and 160 hospitalised cases. Less than one-third (26.25%; 42) of the patients hospitalised were vaccinated compared to almost 40.0% (39.02%; 240) of the patients seen at the OPD. Vaccinated individuals were nearly three times (aOR = 2.72, 95%CI:1.74-4.25) more likely to be managed on an outpatient basis as compared to the unvaccinated. The death rate among the vaccinated group and the unvaccinated were (0.71%; 2) and (3.45%; 17), respectively, with a significant reduction in the risk of dying among the vaccinated compared to the unvaccinated (aOR = 0.13, 95%CI: 0.028 0.554).
CONCLUSIONS
Less than half of the in-patient and OPD patients were vaccinated. Mild infections, fewer days of hospitalisation, outpatient treatment and higher chances of survival were associated with being vaccinated against SARS-CoV-2. Prudent measures should be implemented to encourage the general public to take up SARS-CoV-2 vaccines.
FUNDING
None declared.
Topics: Humans; COVID-19; Ghana; Male; Female; Retrospective Studies; COVID-19 Vaccines; Middle Aged; Adult; Hospitalization; Vaccination; SARS-CoV-2; Aged; Length of Stay; Young Adult; Adolescent
PubMed: 38957848
DOI: 10.4314/gmj.v57i4.6 -
Ghana Medical Journal Dec 2023To assess the knowledge and acceptability of COVID-19 vaccines among HCWs.
OBJECTIVES
To assess the knowledge and acceptability of COVID-19 vaccines among HCWs.
DESIGN
A descriptive cross-sectional study was conducted in March 2021 among eligible HCWs using a self-administered questionnaire.
SETTING
The study was conducted in a southern Nigerian tertiary hospital.
PARTICIPANTS
All HCWs not on annual or study leave were eligible to participate. The number of HCWs in each occupational category was determined by proportional allocation. HCWs were selected by stratified sampling technique.
MAIN OUTCOME MEASURES
Knowledge of COVID-19 vaccines was assessed using 25 questions. The minimum and maximum scores were 0 and 25, respectively. Scores were converted to percentages. Scores of 50% and above were rated as good knowledge. Participants were also asked if they were willing to receive the vaccine.
RESULTS
The mean age of 512 participating HCWs was 33.4±7.8 with an M:F ratio of 1:1.1. Overall, 399 (76.6%) had good knowledge. Occupation and exposure to COVID-19 were predictors of knowledge. Three hundred and twenty-eight respondents (63.0%) were willing to take the vaccine. Predictors of willingness to accept vaccination were age, sex, number of years in employment and knowledge about the vaccines (p< 0.05).
CONCLUSIONS
Most HCWs had good knowledge and were disposed to accepting the COVID-19 vaccine. Educational interventions are necessary to improve HCWs knowledge as they may provide vaccine-related information to the general public.
FUNDING
None declared.
Topics: Humans; Female; Male; Adult; Nigeria; Cross-Sectional Studies; Tertiary Care Centers; COVID-19 Vaccines; Health Knowledge, Attitudes, Practice; COVID-19; Surveys and Questionnaires; Health Personnel; Middle Aged; SARS-CoV-2; Young Adult; Patient Acceptance of Health Care; Vaccination
PubMed: 38957845
DOI: 10.4314/gmj.v57i4.5