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A Retrospective Analysis of the Effects of Pneumonia and Chronic Obstructive Pulmonary Disease on Patient Mortality in Southwest Missouri
Get PDFChronic obstructive pulmonary disease (COPD) is a progressive lung disease. In this study, we aimed to explore the effects of COPD and pneumonia on the mortality rates among patients admitted to the Freeman Health System in Southwest Missouri, to provide a better idea of whether there is a correlation between the two and whether the presence of both adds to the mortality rates. Patient data were extracted from electronic medical records, focusing on patients with or without COPD and pneumonia diagnoses. Analyses revealed a statistical difference, with a p-value of \u3c0.0001, in mortality rates between COPD patients with (P1) and without (P3) pneumonia, indicating that pneumonia did have an impact on COPD patients. However, pneumonia patients without COPD (P2) had a higher, but non-statistical difference in mortality rates compared to COPD patients with pneumonia (P1), with a p-value of 0.0806. These findings emphasize the severe influence of pneumonia in both COPD and non-COPD populations in the area, warranting further investigation and emphasizing the importance of timely and appropriate treatment. These results provide insights into the interplay between COPD and pneumonia in the geographic area, which may provide guidance in treatment decisions that may improve patient outcomes
Penicillin Allergy Reassessment for Treatment Improvement: A Dental Office Tool to Support Appropriate Penicillin Allergy Labeling
No full textBackground: Dental appointments offer an opportunity to evaluate a documented penicillin (PCN) allergy and determine whether the patient might be a candidate for medical reassessment of their allergy. The authors gathered feedback on the Penicillin Allergy Reassessment for Treatment Improvement (PARTI) tool, designed to enhance dentist-patient communications regarding PCN allergies.
Methods: From January 2022 through May 2023, the authors conducted a mixed-methods study, collecting focus group data from patients with PCN allergies and surveying health care workers (HCWs) regarding the PARTI tool. Feedback focused on reassessment procedures, patient-centered allergy information, and medical records updates. Thematic analysis was used for focus group data.
Results: The study included 15 patients in focus groups and 50 HCW survey respondents representing diverse US regions. Patient demographic characteristics included varied races, the mean age was 52 years, and most of the patients were female (53.3%). Most patients had health care interactions within the preceding year, at which 86.6% of patients were asked about drug allergies. HCW respondents primarily consisted of pharmacists (30%) and dentists, dental hygienists, and dental assistants (28%). Feedback on the PARTI tool was constructive, with both patients and HCWs recognizing its potential benefits and providing insights for improvement. Many HCWs (68%) highlighted the importance of step 3 of the PARTI tool, that is, the section on PCN allergy testing. Feedback from participants was incorporated into the final PARTI tool.
Conclusions: Patient and HCW feedback on the PARTI tool was used to finalize a tool for the dental office to provide to patients who are candidates for PCN allergy reassessment. The feedback will also be used to inform an upcoming pilot study in US dental offices, focused on the process for PCN allergy reassessment and health record documentation.
Practical implications: Deploying the PARTI tool in dental offices is pivotal, as mislabeling patients with PCN allergies could have severe consequences, such as hindering the prescription of lifesaving antibiotics for conditions like endocarditis, in the future. This implementation not only enhances communication between dentists and patients, but it is also crucial for ensuring improved patient safety and maintaining accurate medical records among health care settings
mHealth Learning Strategies to Support Behaviour Change in Individuals Using Wheelchairs and/or Scooters: A Systematic Review
No full textPurpose: The purpose of this systematic review of the literature is to build understanding of the key elements and recommendations for the design of mHealth technology for individuals using wheelchairs and/or scooters and identify key features associated with the use of mHealth to support healthy behaviour changes for this population.
Materials and methods: Eight major electronic databases were systematically searched to identify mobile health (mHealth) interventions, which targeted adult WC/S users. Independent reviewers used Endnote and Covidence to manage articles meeting review criteria and to exclude duplicates. A quality assessment was conducted on each included article.
Results: Nine articles describing studies with diverse study designs met criteria to be included in this review. Several interactive application intervention features, such as participant collaboration and goal setting, and key technical features to support mHealth app development and utilisation were identified. Results found intuitive and simple designs of mHealth apps, with the ability to customise to support learning styles and preferences, support usability and acceptability by participants.
Conclusions: More research is needed to evaluate best practices to support initial training of end-users, mHealth apps\u27 ability to support long-term behaviour change and maintenance, and the understanding of active ingredients in complex interventions that include mHealth apps. Both interactive mHealth application intervention and technical features support healthy behaviour change among individuals using wheelchairs and scooters
Racial Disparities in Patterns and Modes of Current and Daily Marijuana Use among Adults Living with Children
No full textObjective: This study sought to examine racial disparities in marijuana use among U.S. adults living with children.
Methods: Data are drawn from the 2022 Behavioral Risk Factor Surveillance System to examine the prevalence of current (past month) and frequent (≥20 days in the last 30 days) marijuana use along with the mode of marijuana use by 7 racial and ethnic groups (non-Hispanic [NH] White, NH-Black, Hispanic, NH American Indian or Alaskan Native [AI/AN], NH-Asian, NH Native Hawaiian or other Pacific Islander only [NH/PI], and other/multiple races, n=22,659).
Results: Compared to NH White adults with children, NH Black adults had a higher prevalence of current marijuana use (23.1% vs. 16.9%, p=0.003) and NH AI/AN adults had two times higher prevalence of frequent use (17.3% vs. 8.4%, p=0.0003). Adults living in recreational marijuana legal states (vs. no) were also more likely to report marijuana use, and there were significant age × race/ethnicity and education × race/ethnicity interactions (p
Conclusions and relevance: Substantial racial disparities in marijuana use patterns among adults who live with children highlight a potential risk for adolescents\u27 health. Addressing these differences is essential for promoting equitable health outcomes in diverse communities
Barriers in Office-Based Opioid Treatment in Rural United States
Get PDFBackground
The opioid crisis has severely impacted health outcomes in the United States, particularly in rural areas, where barriers to medication-based treatment for opioid use disorder (OUD) persist. Although medication-assisted treatment (MAT) for OUD is effective, access remains limited, especially in these communities.
Aim
This study identifies and examines barriers to accessing office-based OUD treatment in rural areas of the United States.
Methods
We conducted a cross-sectional survey of 49 adults with OUD treated at an outpatient facility in rural Missouri. The survey assessed familiarity with OUD medications, barriers to accessing treatment, difficulties finding providers, and support systems. Data were analyzed using descriptive statistics and chi-square tests to compare accessibility and emotional barriers.
Results
The primary barriers identified were related to accessibility (54%), including costs, insurance, clinic hours, and transportation, significantly outweighing emotional barriers like stigma or lack of support (26%). Accessibility barriers were notably higher than cases reporting no barriers (p\u3c0.01) and higher than those who reported emotional barriers (p\u3c.05). This highlights the need for improved infrastructure and support.
Conclusion
Cost, insurance, clinic location, and limited clinic hours are significant obstacles to OUD treatment in rural areas. Addressing these barriers through strategies like expanded clinic hours, telehealth, transportation assistance, and physician education is essential to improving access to care for OUD patients in rural settings
Nutrition, Obesity, and Seborrheic Dermatitis: Systematic Review
Get PDFBackground:
Pathogenesis of seborrheic dermatitis involves lipid secretion by sebaceous glands, Malassezia colonization, and an inflammatory response with skin barrier disruption. Each of these pathways could be modulated by diet, obesity, and nutritional supplements. Current treatment options provide only temporary control of the condition; thus, it is essential to recognize modifiable lifestyle factors that may play a role in determining disease severity.
Objective:
This study aimed to summarize published evidence on diet, nutritional supplements, alcohol, obesity, and micronutrients in patients with seborrheic dermatitis and to provide useful insights into areas of further research.
Methods:
A literature search of Scopus, PubMed, and MEDLINE (Ovid interface) for English language papers published between 1993 and 2023 was conducted on April 16, 2023. Case-control studies, cohort studies, and randomized controlled trials with 5 or more subjects conducted on adult participants (\u3e14 years) were included, case reports, case series, and review papers were excluded due to insufficient level of evidence.
Results:
A total of 13 studies, 8 case-control, 3 cross-sectional, and 2 randomized controlled trials, involving 13,906 patients were included. Seborrheic dermatitis was correlated with significantly increased copper, manganese, iron, calcium, and magnesium concentrations and significantly lower serum zinc and vitamin D and E concentrations. Adherence to the Western diet was associated with a higher risk for seborrheic dermatitis in female patients and an increased consumption of fruit was associated with a lower risk of seborrheic dermatitis in all patients. The prebiotic Triphala improved patient satisfaction and decreased scalp sebum levels over 8 weeks. Most studies find associations between regular alcohol use and seborrheic dermatitis, but the association between BMI and obesity on seborrheic dermatitis severity and prevalence is mixed.
Conclusions:
This review sheds light on specific promising areas of research that require further study, including the need for interventional studies evaluating serum zinc, vitamin D, and vitamin E supplementation for seborrheic dermatitis. The negative consequences of a Western diet, alcohol use, obesity, and the benefits of fruit consumption are well known; however, to fully understand their specific relationships to seborrheic dermatitis, further cohort or interventional studies are needed
Safety and Tolerability of Phenylbutyrate in Inclusion Body Myositis
Get PDFIntroduction
Phenylbutyrate (PBA) showed positive effect on the muscle cell model of Inclusion Body Myositis (IBM) by improving lysosomal activity, ameliorating consequences of impaired autophagy, and decreasing vacuolization. This provides rationale to study this medication in patients with IBM.
Objectives
To evaluate the safety and tolerability of phenylbutyrate in IBM, and monitor for any early signal of effectiveness.
Methods
Open-label study of 10 subjects with IBM who received treatment with PBA for 3 months after a 3-month run-in period. The PBA dose was 3 gm twice daily. The primary outcome measure was adverse event reporting. Secondary outcome measures included manual muscle testing, timed up and go test, IBM functional rating scale, and grip strength, along with exploratory biomarkers evaluating the mitochondrial function, stress response, degenerative process, and apoptosis.
Results
Ten subjects completed the study. PBA was well tolerated with no serious adverse events related to it. The most common adverse events were gastrointestinal related and did not require stopping treatment. One of the biomarkers (MitoTracker) showed a statistically significant drop over the treatment period of the study (p-value of 0.02 for the mean change). There were no statistically significant changes in other secondary outcome measures, but the study was limited by a small sample size and short treatment period.
Conclusions
Phenylbutyrate was safe and well tolerated in patients with IBM in this pilot study. The change in the MitoTracker suggests target engagement, but a Phase II study is needed to confirm and study the efficacy of PBA in IBM
Anatomical Considerations for the Use of the Popliteal Vein as a Potential Alternative for Central Venous Cannulation
Get PDFLimited reports have evaluated the utility of the popliteal vein (PV) specific to cannulation. The objective of this study was to characterize the diameter and length of the PV to evaluate this area as a potential cannulation site. The popliteal region in 23 formalin-embalmed, prosected donors was dissected, and the PV was exposed from the adductor hiatus (AH) superiorly to the small saphenous vein (SSV) inferiorly. The diameter of the popliteal vein was measured at the AH, SSV, and half of the distance from the AH to the SSV (MID) using a brass plumb bob. The length of the PV was measured to the AH, SSV, MID, and femoral condyles (FCs). Overall, the mean diameters and mean lengths for the combined population were calculated, as well as individual limbs (right, left) and anatomical sex. Univariate analysis used to evaluate differences in mean diameter and length measurements based on anatomical sex revealed significant differences (p \u3c 0.05) for both diameter and length at all the landmarks evaluated. Multivariate analysis of PV diameter at the AH and SSV landmarks was statistically significant (p \u3c 0.05) when laterally and anatomical comparing sex. These data provide full characterization of the PV in support of its utility in vascular access
Evaluating the Impact of Tubular Retractors in Glioma Surgery: A Systematic Review and Meta-analysis
No full textBackground: Achieving safe, maximal tumor resection in gliomas can be challenging due to the tumor\u27s intricate relationship with surrounding structures. Tubular retractors offer a minimally invasive approach, preserving functional pathways and reducing complications. To assess their efficacy and safety, we conducted a systematic review and meta-analysis.
Methods: A search across databases identified 26 studies meeting inclusion criteria, encompassing 106 patients with various glioma types and tumor locations.
Results: Among 26 eligible studies, 15 provided sufficient data on 106 patients (median age: 50.5 years). Glioblastoma multiforme constituted 52.4 % of tumors, followed by IDH-mutant astrocytomas at 31.0 %. Tumor locations varied, with intraventricular and thalamic involvement in 16.3 % (16/98) of cases, followed by temporal (12.2 %), frontal and occipital (each 8.16 %), basal ganglia (8.16 %), parietal (7.14 %), optic pathway (2.04 %), and caudate nucleus (1.02 %) involvement. VyCor and Brainpath retractors were most used (22.6 % and 21.7 %, respectively). Tubular retractors were often combined with the exoscope (35.9 %). Gross total resection (GTR) was achieved in 69.4 % of cases, near-total resection (NTR) in 5.1 %, and subtotal resection/partial resection (STR/PR) in 25.5 %. Mean extent of resection (EOR) significantly differed between GTR and STR/NTR/PR groups (p
Conclusion: Tubular retractors are a valuable intraoperative adjunct and component of the surgical armamentarium for glioma surgery allowing bimanual operative techniques to manage hemostasis directly with excellent surgical outcomes and an acceptable complication profile