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JACC. Advances Dec 2023
PubMed: 38938480
DOI: 10.1016/j.jacadv.2023.100712 -
Frontiers in Psychiatry 2024There is a reported high prevalence of anxiety in people with autism spectrum disorder. This mini review appraises existing research investigating heart rate variability... (Review)
Review
There is a reported high prevalence of anxiety in people with autism spectrum disorder. This mini review appraises existing research investigating heart rate variability biofeedback to help manage symptoms of anxiety in people with autism spectrum disorder. A thorough search of electronic databases was conducted to find relevant literature. Consultation with experts and a librarian helped develop search terms following the PICO framework. Five databases were searched, and screening was undertaken using Covidence software, with the process outlined in a PRISMA flowchart. The latest review showed positive short-term effects but there is a need for long-term follow-up. Future investigations should consider device type, training settings, and control interventions. Accurate heart rate variability assessment independent of biofeedback devices is crucial. Additional measures like cortisol assessment and user feedback are recommended for comprehensive evaluation. The findings highlight progress in the evidence base and offer insight to future directions.
PubMed: 38938467
DOI: 10.3389/fpsyt.2024.1409173 -
Frontiers in Medicine 2024Medical errors are not uncommon, but they are seldom reported. Patient safety practices are among the key areas for service improvement. This study aimed to assess...
INTRODUCTION
Medical errors are not uncommon, but they are seldom reported. Patient safety practices are among the key areas for service improvement. This study aimed to assess factors associated with self-reported medical errors among undergraduate health science students in southern Ethiopia.
METHODS
A facility-based cross-sectional study was conducted among health science students of Arba Minch University in 2018. The sample size was calculated using a single population proportion formula. A total of 287 medical students in their fourth year and above, nursing and midwifery students in their second year and above, and other health science students in their third year and above were included.
RESULTS
The majority (82.1, 95%CI: 77.63-86.67) of the study participants had a 'good' knowledge score on patient safety. Approximately 62.5% (95%CI: 56.8-68.2) of the participants had a 'favorable' patient safety attitude. Only 38.6% (95%CI: 32.8-44.3) of the study participants had 'good' patient safety practices. At adjusted analysis, the practical attachment unit, having ever managed a patient independently, having ever witnessed harm to patients by colleagues or other healthcare workers, and having ever witnessed harm to a close friend or family member were statistically significantly associated with self-reported medical errors. Participants who were doing their practical clinical attachment in the surgical and obstetric units were three times more likely to self-report medical errors as compared to those practicing in the pediatrics, internal medicine, and other units (AOR = 2.72, 95%CI: 1.16-6.39.97). Students who had never managed a patient independently were less likely to self-report medical error (AOR = 0.24, 95%CI: 0.08-0.72). The odds of self-reporting medical errors were less among among participants who had not ever witnessed harm to patients by colleagues or other healthcare workers (AOR = 0.12, 95%CI: 0.05-0.29) and participants who had not ever witnessed harm to a close friend or family member (AOR = 0.36, 95%CI: 0.16-0.80).
CONCLUSION
One in five of the participants reported having harmed patients while practicing. Most of the students had good patient safety knowledge, while approximately two-thirds of the participants had a favorable attitude toward patient safety. Only 38.6% of the study participants had good patient safety practices. Having worked in surgical and obstetrics units, having managed a patient independently, and having witnessed harm to a patient were associated with self-reporting of medical errors.
PubMed: 38938384
DOI: 10.3389/fmed.2024.1354270 -
JACC. Advances Oct 2023There is emerging evidence that malnutrition is associated with poor prognosis among patients with acute coronary syndrome (ACS).
BACKGROUND
There is emerging evidence that malnutrition is associated with poor prognosis among patients with acute coronary syndrome (ACS).
OBJECTIVES
This study seeks to elucidate the prognostic impact of malnutrition in patients with ACS and provide a quantitative review of most commonly used nutritional assessment tools.
METHODS
Medline and Embase were searched for studies reporting outcomes in patients with malnutrition and ACS. Nutritional screening tools of interest included the Prognostic Nutrition Index, Geriatric Nutritional Risk Index, and Controlling Nutritional Status. A comparative meta-analysis was used to estimate the risk of all-cause mortality and cardiovascular events based on the presence of malnutrition and stratified according to ACS type, ACS intervention, ethnicity, and income.
RESULTS
Thirty studies comprising 37,303 patients with ACS were included, of whom 33.5% had malnutrition. In the population with malnutrition, the pooled mortality rate was 20.59% (95% CI: 14.95%-27.67%). Malnutrition was significantly associated with all-cause mortality risk after adjusting for confounders including age and left ventricular ejection fraction (adjusted HR: 2.66, 95% CI: 1.78-3.96, = 0.004). There was excess mortality in the group with malnutrition regardless of ACS type ( = 0.132), ethnicity ( = 0.245), and income status ( = 0.058). Subgroup analysis demonstrated no statistically significant difference in mortality risk between individuals with and without malnutrition ( = 0.499) when using Controlling Nutritional Status (OR: 7.80, 95% CI: 2.17-28.07, = 0.011), Geriatric Nutritional Risk Index (OR: 4.30, 95% CI: 2.78-6.66, < 0.001), and Prognostic Nutrition Index (OR: 4.67, 95% CI: 2.38-9.17, = 0.023).
CONCLUSIONS
Malnutrition was significantly associated with all-cause mortality risk following ACS, regardless of ACS type, ethnicity, and income status, underscoring the importance of screening and interventional strategies for patients with malnutrition.
PubMed: 38938362
DOI: 10.1016/j.jacadv.2023.100635 -
JACC. Advances Oct 2023
PubMed: 38938340
DOI: 10.1016/j.jacadv.2023.100621 -
Clinical Kidney Journal May 2024Worldwide, most people requiring kidney replacement therapy receive haemodialysis (HD) three times per week. Greater HD time and/or frequency may improve survival, but...
BACKGROUND
Worldwide, most people requiring kidney replacement therapy receive haemodialysis (HD) three times per week. Greater HD time and/or frequency may improve survival, but implementation requires understanding potential benefits across the range of patients.
METHODS
Using data from the Australia and New Zealand Dialysis and Transplant Registry, we assessed whether quotidian HD (defined as >3 sessions/week and/or >5 h/session) was associated with reduced mortality in adult patients. The primary outcome of all-cause mortality was analysed by a time-varying Cox proportional hazards model with quotidian HD as the exposure of interest.
RESULTS
Of 24 138 people who received HD between 2011 and 2019, 2632 (10.9%) received quotidian HD at some stage. These patients were younger, more likely male and more likely to receive HD at home. Overall, quotidian versus standard HD was associated with a decreased risk for all-cause mortality {crude hazard ratio [HR] 0.50 [95% confidence interval (CI) 0.45-0.56]}, but an interaction between quotidian HD and age was identified ( = .005). Stratified by age groups and splitting follow-up time where proportional hazards were violated, the corresponding HR compared with standard HD was 2.43 (95% CI 1.56-3.79) for people >75 years of age in the first year of quotidian HD, 1.52 (95% CI 0.89-2.58) for 1-3 years and 0.95 (95% CI 0.51-1.78) for ≥3 years. There was no significant survival advantage in younger people.
CONCLUSIONS
Although quotidian HD conferred survival benefit in crude analyses, people ≥75 years of age had greater mortality with quotidian HD than standard HD. The mortality benefit in younger people was attenuated when adjusted for known confounders.
PubMed: 38938326
DOI: 10.1093/ckj/sfae103 -
Health Affairs Scholar Jun 2024Geographic variation in hardship, especially health-related hardship, was identified prior to and during the pandemic, but we do not know whether this variation is...
Geographic variation in hardship, especially health-related hardship, was identified prior to and during the pandemic, but we do not know whether this variation is consistent among Veterans Health Administration (VHA)-enrolled veterans, who reported markedly high rates of financial hardship during the pandemic, despite general and veteran-specific federal policy efforts aimed at reducing hardship. In a nationwide, regionally stratified sample of VHA-enrolled veterans, we examined whether the prevalence of financial hardship during the pandemic varied by US Census region. We found veterans in the South, compared with those in other census regions, reported higher rates of severe-to-extreme financial strain, using up all or most of their savings, being unable to pay for necessities, being contacted by collections, and changing their employment due to the kind of work they could perform. Regional variation in veteran financial hardship demonstrates a need for further research about the role and interaction of federal and state financial-assistance policies in shaping risks for financial hardship as well as potential opportunities to mitigate risks among veterans and reduce variation across regions.
PubMed: 38938272
DOI: 10.1093/haschl/qxae075 -
Anesthesiology Research and Practice 2024Goal-directed fluid therapy (GDFT) contributes to improvements in intraoperative fluid infusion based on objective parameters and has been widely recommended in clinical...
The Effect of Colloids versus Crystalloids for Goal-Directed Fluid Therapy on Prognosis in Patients Undergoing Noncardiac Surgery: A Meta-Analysis of Randomized Controlled Trials.
BACKGROUND
Goal-directed fluid therapy (GDFT) contributes to improvements in intraoperative fluid infusion based on objective parameters and has been widely recommended in clinical practice. In addition, increasing evidence reveals that GDFT can improve the prognosis of surgical patients. However, considering the individual characteristics of colloids and crystalloids in clinical use, it is uncertain as to which type of fluids administered is associated with better outcomes in the condition of GDFT.
OBJECTIVES
To evaluate the effect of colloids versus crystalloids under GDFT on prognosis in patients undergoing noncardiac surgery. . Randomized controlled trials (RCTs) from PubMed, EMBASE, Ovid MEDLINE, CNKI, Cochrane library, and reference lists of relevant articles.
METHODS
Two investigators independently screened and reviewed studies for inclusion and performed data extraction. Our primary outcome was a composite of postoperative complications. The secondary outcomes were (1) mortality at the follow-up duration; (2) postoperative complications of several organ systems, including cardiac, pulmonary, digestive, urinary, nervous system, and postoperative infection events; and (3) hospital and ICU length of stay. Heterogeneity was assessed by the and chi-square tests. The odds ratio (OR) of the dichotomous data, mean difference (MD) of continuous data, and 95% confidence intervals (CI) were calculated to assess the pooled data.
RESULTS
Of 332 articles retrieved, 15 RCTs (involving 2,956 patients undergoing noncardiac surgery) were included in the final analysis. When the data were pooled, patients in the colloids and crystalloids group revealed no difference in postoperative composite complications (OR = 0.84, 95% CI = 0.51-1.38, =0.49) under GDFT. Regarding the secondary outcomes, patients in the colloids group were associated with fewer digestive system complications (OR = 0.64, 95% CI = 0.41-0.98, =0.04). However, no difference was found in mortality (OR = 1.37, 95% CI = 0.72-2.58, =0.34), complications of the cardiac system (OR = 1.49, 95% CI = 0.66-3.37, =0.34), pulmonary system (OR = 0.89, 95% CI = 0.62-1.28, =0.53), urinary system (OR = 1.05, 95% CI = 0.61-1.80, =0.87), nervous system (OR = 1.04, 95% CI = 0.55-1.98, =0.90), postoperative infection events (OR = 0.89, 95% CI = 0.75-1.07, =0.22), length of hospital stay (difference in mean = -0.71, 95% CI = -1.49-0.07, =0.07), and ICU stay (difference in mean = -0.01, 95% CI = -0.20-0.18, =0.95) between patients receiving GDFT with colloids or crystalloids.
CONCLUSION
There is no evidence of a benefit in using colloids over crystalloids under GDFT in patients undergoing noncardiac surgery, despite its use resulting in lower digestive system complications.
PubMed: 38938262
DOI: 10.1155/2024/4386447 -
JACC. Advances Jun 2023Symptoms associated with severe aortic stenosis (AS) are used to guide management.
BACKGROUND
Symptoms associated with severe aortic stenosis (AS) are used to guide management.
OBJECTIVES
The purpose of this study was to examine the pattern of symptoms, comorbidities, and cardiac damage in moderate and severe AS.
METHODS
A total of 846,198 echocardiographic investigations from 330,940 individuals aged >18 years were selected for the most recent echocardiogram, moderate or severe AS (mean gradient 20.0-39.9 mm Hg, aortic valve peak gradient 3.0-3.9 m/s and aortic valve area >1.0 cm; or 40.0 mm Hg, ≥4.0 m/s or ≤1.0 cm, respectively), and a cardiologist consultation. Natural Language Processing was applied to letters to extract comorbidities, dyspnea, chest pain, and syncope. Patients with prior aortic valve replacement were excluded.
RESULTS
2,213 patients (0.7% overall, 32.8% females) had moderate and 3,416 (1.0%, 47.3% females) had severe AS. Comorbidities were common, including hypertension, (56.6% moderate AS, 53.1% severe AS, = 0.01), coronary disease (46.0% and 46.8%, respectively, = 0.58) and atrial fibrillation (29.6% and 34.8%, respectively, < 0.001). Symptoms were also common in moderate (n = 915, 41.3%) and severe (n = 1,630, 47.7%) AS ( < 0.001). Comorbidities were more likely in symptomatic vs asymptomatic patients ( < 0.001). Dyspnea was more likely in severe AS, whereas angina and syncope were similar in moderate vs severe AS. In multivariable analysis, only dyspnea was associated with severe (vs moderate) AS (OR: 1.73, 95% CI: 1.41-2.13, < 0.001). In both adjusted and unadjusted models, the degree of cardiac damage did not relate to presence of any symptoms but was associated with AS severity.
CONCLUSIONS
Dyspnea is common in moderate and severe AS, is associated with comorbidities and is not related to the degree of cardiac damage. Symptom-guided management decisions in AS may need revision.
PubMed: 38938261
DOI: 10.1016/j.jacadv.2023.100356 -
Health Expectations : An International... Aug 2024Experience-Based Co-Design (EBCD) is a multi-stage participatory action research process which was developed originally to increase patient involvement in service...
BACKGROUND
Experience-Based Co-Design (EBCD) is a multi-stage participatory action research process which was developed originally to increase patient involvement in service improvement initiatives. This viewpoint article serves as a reflection on the researchers' experiences, focusing on the application and feasibility of participatory approaches, particularly co-design, in the specific context of early-phase clinical trials.
METHODS
We reflect on the opportunities and challenges of applying EBCD in a new context of early-phase clinical trials in oncology where experimental treatments are increasingly perceived as a therapeutic option and, in certain instances, their efficacy may lead to accelerated approval facilitating a swifter integration into standard care.
RESULTS
We propose that the opportunity of applying EBCD in such trials lies in improving the delivery of person-centered care, care coordination, and support during the transition from experimental to standard care. Three potential challenges when applying EBCD in early-phase clinical trials are discussed related to: the need for standardization in trial processes; planning EBCD in a context of high uncertainty; and vulnerability of patient populations.
CONCLUSION
Integrating EBCD into early-phase oncology trials presents an opportunity to enhance person-centered care and can lead to simultaneous improvements in care processes and therapeutic development.
PATIENT OR PUBLIC CONTRIBUTION
This article has been developed with the collaboration of a patient partner who serves on the advisory board of our ongoing EBCD study in early clinical trials.
Topics: Humans; Medical Oncology; Research Design; Clinical Trials, Phase I as Topic; Patient-Centered Care; Patient Participation; Health Services Research; Neoplasms
PubMed: 38937953
DOI: 10.1111/hex.14068