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The Journal of Hospital Infection Jun 2024Emergency departments (EDs) are a critical entry gate for infectious agents into hospitals. In this interdisciplinary study, we explore how infection prevention and...
INTRODUCTION
Emergency departments (EDs) are a critical entry gate for infectious agents into hospitals. In this interdisciplinary study, we explore how infection prevention and control (IPC) architectural interventions mitigate the spread of emerging respiratory pathogens using the example of SARS-CoV-2 in a prototypical ED.
METHODS
Using an agent-based approach, we integrate data on patients' and healthcare workers' (HCWs) routines and the architectural characteristics of key ED areas. We estimate the number of transmissions in the ED by modelling the interactions between and among patients and HCWs. Architectural interventions are guided towards the gradual separation of pathogen carriers, compliance with a minimum interpersonal distance, and deconcentrating airborne pathogens (higher air exchange rates (AERs)). Interventions are epidemiologically evaluated for their mitigation effects on diverse endpoints.
RESULTS
Simulation results indicate that higher AERs in the ED (compared to baseline) may provide a moderate level of infection mitigation (incidence rate ratio (IRR) of 0.95 (95% CI 0.93 - 0.98)) while the overall burden decreases more when separating rooms in examination areas (IRR of 0.78 (95% CI 0.76 - 0.81)) or when increasing the size of the ED base (IRR of 0.79 (95% CI 0.78 - 0.81)). The reduction in SARS-CoV-2-associated nosocomial transmissions is largest when combining architectural interventions (IRR of 0.61 (95% CI 0.59 - 0.63)).
CONCLUSIONS
These modelling results highlight the importance of IPC architectural interventions; they can be devised independently of profound knowledge of an emerging pathogen, focusing on technical, constructive, and functional components. These results may inform public health decision-makers and hospital architects on how IPC architectural interventions can be optimally used in healthcare premises.
PubMed: 38885930
DOI: 10.1016/j.jhin.2024.05.019 -
European Radiology Experimental Jun 2024Radiomics is a quantitative approach that allows the extraction of mineable data from medical images. Despite the growing clinical interest, radiomics studies are... (Comparative Study)
Comparative Study
BACKGROUND
Radiomics is a quantitative approach that allows the extraction of mineable data from medical images. Despite the growing clinical interest, radiomics studies are affected by variability stemming from analysis choices. We aimed to investigate the agreement between two open-source radiomics software for both contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) of lung cancers and to preliminarily evaluate the existence of radiomic features stable for both techniques.
METHODS
Contrast-enhanced CT and MRI images of 35 patients affected with non-small cell lung cancer (NSCLC) were manually segmented and preprocessed using three different methods. Sixty-six Image Biomarker Standardisation Initiative-compliant features common to the considered platforms, PyRadiomics and LIFEx, were extracted. The correlation among features with the same mathematical definition was analyzed by comparing PyRadiomics and LIFEx (at fixed imaging technique), and MRI with CT results (for the same software).
RESULTS
When assessing the agreement between LIFEx and PyRadiomics across the considered resampling, the maximum statistically significant correlations were observed to be 94% for CT features and 95% for MRI ones. When examining the correlation between features extracted from contrast-enhanced CT and MRI using the same software, higher significant correspondences were identified in 11% of features for both software.
CONCLUSIONS
Considering NSCLC, (i) for both imaging techniques, LIFEx and PyRadiomics agreed on average for 90% of features, with MRI being more affected by resampling and (ii) CT and MRI contained mostly non-redundant information, but there are shape features and, more importantly, texture features that can be singled out by both techniques.
RELEVANCE STATEMENT
Identifying and selecting features that are stable cross-modalities may be one of the strategies to pave the way for radiomics clinical translation.
KEY POINTS
• More than 90% of LIFEx and PyRadiomics features contain the same information. • Ten percent of features (shape, texture) are stable among contrast-enhanced CT and MRI. • Software compliance and cross-modalities stability features are impacted by the resampling method.
Topics: Humans; Lung Neoplasms; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Carcinoma, Non-Small-Cell Lung; Software; Male; Female; Middle Aged; Aged; Contrast Media; Radiomics
PubMed: 38880866
DOI: 10.1186/s41747-024-00468-8 -
Medicine Jun 2024Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated motor sensory peripheral neuropathy that is rare in clinical practice. This treatment...
RATIONALE
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated motor sensory peripheral neuropathy that is rare in clinical practice. This treatment method aims to suppress potential immunopathology. Nocardiosis is a rare, destructive, opportunistic disease. We report a case of failed treatment of CIDP combined with pulmonary nocardiosis, and for the first time, we link these 2 diseases together.
PATIENT CONCERNS
A 65-year-old man developed symmetrical limb weakness. Four months later, he was diagnosed with CIDP and started receiving glucocorticoid (GC) treatment. The disease progressed slowly and was treated with mycophenolate mofetil (MMF) in combination. He did not follow the doctor requirements for monthly follow-up visits, and the preventive medication for sulfamethoxazole/trimethoprim was not strictly implemented. Two months after the combination therapy, the patient developed fever, coughing and sputum production, as well as fatigue and poor appetite. Based on imaging and etiological results, he was diagnosed with pulmonary nocardiosis.
DIAGNOSES
Chronic inflammatory demyelinating polyneuropathy, pulmonary nocardiosis.
INTERVENTIONS
After treatment with antibiotics, the patient lung infection temporarily improved. However, the patient CIDP condition progressed, limb weakness worsened, respiratory muscle involvement occurred, and intravenous immunoglobulin (IVIG) was administered. However, there was no significant improvement in the condition, and the patient died.
OUTCOMES
In this report, we present a case of a patient with CIDP and pulmonary nocardiosis. It is worth noting that in order to avoid the progression and recurrence of CIDP, we did not stop using related therapeutic drugs during the treatment process, the patient had repeatedly refused to use IVIG. Despite this, the patient condition worsened when lung inflammation improved, leading to persistent respiratory failure and ultimately death. Treatment contradictions, medication issues, and patient compliance issues reflected in this case are worth considering.
LESSONS
For patients with CIDP receiving immunosuppressive therapy, attention should be paid to the occurrence and severity of Nocardia infection. Therefore, early detection and treatment are necessary. We need to pay attention to the compliance of patients with prophylactic use of antibiotics, strengthen the follow-up, and urge them to return to their appointments on time.
Topics: Humans; Male; Aged; Nocardia Infections; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating; Anti-Bacterial Agents; Immunoglobulins, Intravenous
PubMed: 38875438
DOI: 10.1097/MD.0000000000038544 -
Medicine Jun 2024Budesonide, capable of reducing vascular permeability, suppressing mucus secretion, and alleviating edema and spasms, is widely used in China for combined infectious... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Budesonide, capable of reducing vascular permeability, suppressing mucus secretion, and alleviating edema and spasms, is widely used in China for combined infectious disease treatment. This study assesses budesonide's efficacy and safety as an adjunct to azithromycin in pediatric Mycoplasma pneumonia management in China, aiming to establish a strong theoretical foundation for its clinical application.
METHODS
We conducted a comprehensive search for qualifying studies across 5 English databases and 4 Chinese databases, covering publications until October 31, 2023. Endpoint analyses were performed using standard software (Stata Corporation, College Station, TX). This study was conducted in compliance with the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
RESULTS
A total of 24 randomized controlled trials were involved in the current study, including 2034 patients. Our findings indicate that the combination of budesonide with azithromycin for the treatment of pediatric Mycoplasma pneumonia delivers superior therapeutic efficacy (Intravenous: odds ratio [OR], 0.156, P < .001; Sequential: OR, 0.163, P = .001; Oral: OR, 0.139, P < .001), improved pulmonary function (Forced expiratory volume in 1 second: weighted mean differences [WMD], -0.28, P = .001; Peak expiratory flow: WMD, -0.554, P = .002; Forced vital capacity: WMD, -0.321, P < .001), diminished lung inflammation (IL-6: WMD, 4.760, P = .002; c-reactive protein: WMD, 5.520, P < .001; TNF-α: WMD, 9.124, P < .001), reduced duration of fever, faster resolution of cough and rales, all without increasing the occurrence of adverse events.
CONCLUSION
The combination of budesonide and azithromycin demonstrates enhanced therapeutic effectiveness, promotes improved pulmonary function, shortens the duration of symptoms, and effectively mitigates the overexpression of inflammatory factors like c-reactive protein, TNF-α, and IL-6, all without an associated increase in adverse reactions in pediatric mycoplasma pneumonia.
Topics: Humans; Azithromycin; Pneumonia, Mycoplasma; Budesonide; Child; Drug Therapy, Combination; China; Anti-Bacterial Agents; Administration, Inhalation; Randomized Controlled Trials as Topic; Treatment Outcome; Child, Preschool; East Asian People
PubMed: 38875395
DOI: 10.1097/MD.0000000000038332 -
Scientific Reports Jun 2024The aim of this study was to characterize the systemic cytokine signature of critically ill COVID-19 patients in a high mortality setting aiming to identify biomarkers...
The aim of this study was to characterize the systemic cytokine signature of critically ill COVID-19 patients in a high mortality setting aiming to identify biomarkers of severity, and to explore their associations with viral loads and clinical characteristics. We studied two COVID-19 critically ill patient cohorts from a referral centre located in Central Europe. The cohorts were recruited during the pre-alpha/alpha (November 2020 to April 2021) and delta (end of 2021) period respectively. We determined both the serum and bronchoalveolar SARS-CoV-2 viral load and identified the variant of concern (VoC) involved. Using a cytokine multiplex assay, we quantified systemic cytokine concentrations and analyzed their relationship with clinical findings, routine laboratory workup and pulmonary function data obtained during the ICU stay. Patients who did not survive had a significantly higher systemic and pulmonary viral load. Patients infected with the pre-alpha VoC showed a significantly lower viral load in comparison to those infected with the alpha- and delta-variants. Levels of systemic CTACK, M-CSF and IL-18 were significantly higher in non-survivors in comparison to survivors. CTACK correlated directly with APACHE II scores. We observed differences in lung compliance and the association between cytokine levels and pulmonary function, dependent on the VoC identified. An intra-cytokine analysis revealed a loss of correlation in the non-survival group in comparison to survivors in both cohorts. Critically ill COVID-19 patients exhibited a distinct systemic cytokine profile based on their survival outcomes. CTACK, M-CSF and IL-18 were identified as mortality-associated analytes independently of the VoC involved. The Intra-cytokine correlation analysis suggested the potential role of a dysregulated systemic network of inflammatory mediators in severe COVID-19 mortality.
Topics: Humans; COVID-19; Cytokines; Male; Middle Aged; Female; Intensive Care Units; Aged; SARS-CoV-2; Critical Illness; Viral Load; Biomarkers; Cohort Studies; Pandemics
PubMed: 38871772
DOI: 10.1038/s41598-024-64384-y -
Journal of Medical Internet Research Jun 2024Intensive longitudinal methods offer a powerful tool for capturing daily experiences of individuals. However, its feasibility, effectiveness, and optimal methodological... (Review)
Review
BACKGROUND
Intensive longitudinal methods offer a powerful tool for capturing daily experiences of individuals. However, its feasibility, effectiveness, and optimal methodological approaches for studying or monitoring experiences of oncology patients remain uncertain.
OBJECTIVE
This scoping review aims to describe to what extent intensive longitudinal methods with daily electronic assessments have been used among patients with breast or lung cancer and with which methodologies, associated outcomes, and influencing factors.
METHODS
We searched the electronic databases (PubMed, Embase, and PsycINFO) up to January 2024 and included studies reporting on the use of these methods among adults with breast or lung cancer. Data were extracted on population characteristics, intensive monitoring methodologies used, study findings, and factors influencing the implementation of these methods in research and clinical practice.
RESULTS
We identified 1311 articles and included 52 articles reporting on 41 studies. Study aims and intensive monitoring methodologies varied widely, but most studies focused on measuring physical and psychological symptom constructs, such as pain, anxiety, or depression. Compliance and attrition rates seemed acceptable for most studies, although complete methodological reporting was often lacking. Few studies specifically examined these methods among patients with advanced cancer. Factors influencing implementation were linked to both patient (eg, confidence with intensive monitoring system) and methodology (eg, option to use personal devices).
CONCLUSIONS
Intensive longitudinal methods with daily electronic assessments hold promise to provide unique insights into the daily lives of patients with cancer. Intensive longitudinal methods may be feasible among people with breast or lung cancer. Our findings encourage further research to determine optimal conditions for intensive monitoring, specifically in more advanced disease stages.
Topics: Humans; Lung Neoplasms; Longitudinal Studies; Breast Neoplasms; Female; Adult
PubMed: 38865186
DOI: 10.2196/50224 -
Frontiers in Veterinary Science 2024To compare the cardiopulmonary effects of apneustic anesthesia ventilation (AAV) and conventional mechanical ventilation (CMV) in anesthetized pigs and to describe a new...
OBJECTIVE
To compare the cardiopulmonary effects of apneustic anesthesia ventilation (AAV) and conventional mechanical ventilation (CMV) in anesthetized pigs and to describe a new mode of ventilation for anesthetized veterinary species.
STUDY DESIGN
Randomized, crossover design without washout.
ANIMALS
Twelve healthy, female white Landrace pigs.
METHODS
Following ketamine-midazolam premedication and anesthetic induction with propofol, the trachea was intubated, and each pig was positioned in dorsal recumbency. Anesthesia was maintained with propofol and sufentanil infusions. Pigs were instrumented and their lungs were sequentially ventilated with each mode, in random order, for 1 h according to predefined criteria [fraction of inspired oxygen (FiO) = 0.21, 10 mL kg tidal volume (V), and arterial carbon dioxide tension (PaCO) within 40-45 mmHg]. Cardiopulmonary data were collected at baseline, 30 and 60 min. In 8 pigs, thoracic computed tomography (CT) was performed following the 60 min time point for each mode of ventilation and images were analyzed to quantify lung aeration. The effects of ventilation mode, time, and order were analyzed using repeated measures ANOVA. Paired -tests were used to compare lung aeration between modes. Significance was defined as < 0.05.
RESULTS
Data from 12 pigs were analyzed. A significant effect of mode was found for heart rate, mean arterial pressure (MAP), pulmonary artery occlusion pressure, cardiac index (CI), stroke volume index, systemic vascular resistance, pulmonary vascular resistance, oxygen delivery index (DOI), oxygen extraction ratio (OER), V, arterial oxygen tension, arterial hemoglobin saturation, PaCO, end-tidal carbon dioxide tension, alveolar dead space (V/V), venous admixture ( ), mean airway pressure, and dynamic compliance index (CI). Order effects were also observed for some cardiovascular and respiratory variables. For the eight pigs that underwent thoracic CT, AAV resulted in significantly larger proportions of normally and hyperaerated lung while CMV resulted in larger proportions of hypoaerated and atelectatic lung.
CONCLUSIONS
In dorsally recumbent anesthetized pigs, ventilated with FiO = 0.21, both modes of ventilation supported adequate oxygenation while AAV resulted in higher CI, and lower V/V and , compared with CMV. AAV was also associated with lower MAP, CI, and DOI and higher OER compared with CMV. Further investigation of AAV in anesthetized animals is warranted.
PubMed: 38855412
DOI: 10.3389/fvets.2024.1378617 -
Frontiers in Oncology 2024The purpose of this study was to construct a nomogram model based on the general characteristics, histological features, pathological and immunohistochemical results,...
OBJECTIVE
The purpose of this study was to construct a nomogram model based on the general characteristics, histological features, pathological and immunohistochemical results, and inflammatory and nutritional indicators of patients so as to effectively predict the overall survival (OS) and progression-free survival (PFS) of patients with non-small cell lung cancer (NSCLC) after surgery.
METHODS
Patients with NSCLC who received surgical treatment in our hospital from January 2017 to June 2021 were selected as the study subjects. The predictors of OS and PFS were evaluated by univariate and multivariable Cox regression analysis using the Cox proportional risk model. Based on the results of multi-factor Cox proportional risk regression analysis, a nomogram model was established using the R survival package. The bootstrap method (repeated sampling for 1 000 times) was used to internally verify the nomogram model, and C-index was used to represent the prediction performance of the nomogram model. The calibration graph method was used to visually represent its prediction compliance, and decision curve analysis (DCA) was used to evaluate the application value of the model.
RESULTS
Univariate and multivariate analyses were used to identify independent prognostic factors and to construct a nomogram of postoperative survival and disease progression in operable NSCLC patients, with C-index values of 0.927 (907-0.947) and 0.944 (0.922-0.966), respectively. The results showed that the model had high predictive performance. Calibration curves for 1-year, 2-year, and 3-year OS and PFS show a high degree of agreement between the predicted probability and the actual observed probability. In addition, the results of the DCA curve show that the model has good clinical application value.
CONCLUSION
We established a predictive model of survival prognosis and disease progression in patients with non-small cell lung cancer after surgery, which has good predictive performance and can guide clinicians to make the best clinical decision.
PubMed: 38854735
DOI: 10.3389/fonc.2024.1378135 -
International Journal of Chronic... 2024The relevant factors and patterns of non-adherence to self-management among patients with chronic obstructive pulmonary disease (COPD) need to be elucidated to improve...
Factors Associated with Non-Adherence to Self-Management Among Patients with Chronic Obstructive Pulmonary Disease: A Survey Using the Delphi Technique and Analytic Hierarchy Process.
BACKGROUND
The relevant factors and patterns of non-adherence to self-management among patients with chronic obstructive pulmonary disease (COPD) need to be elucidated to improve self-management.
PURPOSE
This study was a survey to prioritize the relevance of factors associated with non-adherence to COPD self-management using the Delphi technique and analytic hierarchy process (AHP).
PATIENTS AND METHODS
A total of 15 expert panels were established to determine the priority of relevant factors in a three-round Delphi survey and an AHP. To develop the preliminary conceptual framework for non-adherence to COPD self-management, findings from a systematic literature review, a qualitative study using in-depth interviews with COPD patients, and the first round of the Delphi survey were integrated. Based on the preliminary framework, the content validity ratio (CVR) was analyzed to examine the consensus among expert panels in the second and third rounds of the Delphi survey, and the relative weight was determined by pairwise comparisons between alternative factors in the AHP.
RESULTS
In developing the preliminary conceptual framework, 8 factor categories and 53 factors were identified as relevant to non-adherence to COPD self-management. Of the 53 factors, 22 factors with a CVR of 0.49 or higher were identified in the Delphi survey. A total of 14 of the 53 factors were common to both the Delphi survey and AHP with high weights. The most notable factors were prolonged treatment, experience of treatment failure, and unknown effects of medication.
CONCLUSION
Through consensus decision-making by experts, 14 factors were identified as relevant factors associated with non-adherence to COPD self-management. A hierarchical and systematic framework incorporating factors associated with non-adherence to COPD self-management was developed in this study. Further research is needed to develop intervention strategies based on factors associated with non-adherence to COPD self-management.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Delphi Technique; Consensus; Health Knowledge, Attitudes, Practice; Male; Female; Risk Factors; Qualitative Research; Self-Management; Self Care; Aged; Patient Compliance; Middle Aged; Medication Adherence; Lung
PubMed: 38854589
DOI: 10.2147/COPD.S451332 -
Annals of Intensive Care Jun 2024Protective ventilation seems crucial during early Acute Respiratory Distress Syndrome (ARDS), but the optimal duration of lung protection remains undefined. High driving...
BACKGROUND
Protective ventilation seems crucial during early Acute Respiratory Distress Syndrome (ARDS), but the optimal duration of lung protection remains undefined. High driving pressures (ΔP) and excessive patient ventilatory drive may hinder lung recovery, resulting in self-inflicted lung injury. The hidden nature of the ΔP generated by patient effort complicates the situation further. Our study aimed to assess the feasibility of an extended lung protection strategy that includes a stepwise protocol to control the patient ventilatory drive, assessing its impact on lung recovery.
METHODS
We conducted a single-center randomized study on patients with moderate/severe COVID-19-ARDS with low respiratory system compliance (C < 0.6 (mL/Kg)/cmHO). The intervention group received a ventilation strategy guided by Electrical Impedance Tomography aimed at minimizing ΔP and patient ventilatory drive. The control group received the ARDSNet low-PEEP strategy. The primary outcome was the modified lung injury score (LIS), a composite measure that integrated daily measurements of C, along with oxygen requirements, oxygenation, and X-rays up to day 28. The LIS score was also hierarchically adjusted for survival and extubation rates.
RESULTS
The study ended prematurely after three consecutive months without patient enrollment, attributed to the pandemic subsiding. The intention-to-treat analysis included 76 patients, with 37 randomized to the intervention group. The average LIS score up to 28 days was not different between groups (P = 0.95, primary outcome). However, the intervention group showed a faster improvement in the LIS (1.4 vs. 7.2 days to reach 63% of maximum improvement; P < 0.001), driven by oxygenation and sustained improvement of X-ray (P = 0.001). The intervention group demonstrated a sustained increase in C up to day 28 (P = 0.009) and also experienced a shorter time from randomization to room-air breathing (P = 0.02). Survival at 28 days and time until liberation from the ventilator were not different between groups.
CONCLUSIONS
The implementation of an individualized PEEP strategy alongside extended lung protection appears viable. Promising secondary outcomes suggested a faster lung recovery, endorsing further examination of this strategy in a larger trial. Clinical trial registration This trial was registered with ClinicalTrials.gov (number NCT04497454) on August 04, 2020.
PubMed: 38849605
DOI: 10.1186/s13613-024-01297-z