Cup Feeding In the Neonatal ICU: The Influence of Country, Belief, Preference, and Past Behavior

Background/ Purpose: Cup feeding has been identified as a safe alternative for preterm infants who are not able to fully breastfeed, and it has been recommended by international organizations like World Health Organization, yet the practice is limited worldwide. One potential reason this alternative is underutilized is lack of health care providers’ (HCP) knowledge and negative beliefs regarding cup feeding. Jordan and the United States have different health systems, languages, cultures, and economies. A cross cultural comparison of HCP’s knowledge and beliefs in these two contrasting countries may yield some interesting and valuable findings that may further inform clinicians and educators. The purpose of this study is to examine the impact of country, occupation, neonatal health care experience, and level of education on knowledge, beliefs, preference, and past behavior regarding feeding types. Theoretical Framework: The Knowledge-Attitude-Behavior Model was used as a guidance. Methods: A non-experimental cross-cultural correlational design was used to evaluate study goals. A convenient sample of 160 neonatal nurses and physicians from US and Jordan was recruited to complete a web-based survey. Recruitment strategies included Email, website links, and snowballing. Analysis included descriptive, t-test, crosstabs, and Multiple regression analysis. Results: 178 eligible participants submitted the questionnaire online. Among the respondents, 85 were from Jordan and 70 were from US. The average number of years in neonatal health care experience was 13.7 (SD = 12.3), and almost half of the participants (47.7%) had at least 10 years of neonatal health care experience. Almost half of the participants had a BSN or less (55.1%). US sample had more knowledge and positive beliefs about all feeding types, and reported higher overall cup feeding use than Jordanian sample. Physicians had more knowledge and positive believes regarding breast- and cup-feeding, and reported higher feeding preference and practice variables scores than nurses. Participants with at least 10 years of neonatal experience had more knowledge and positive beliefs regarding all feeding types and reported higher overall cup feeding use scores than participants with less than 10 years of neonatal experience. Participants with an advanced degree had more knowledge and positive beliefs regarding all feeding types, and they reported higher cup feeding preference and practice scores than participants with a BSN degree or lower. Conclusions: US Neonatal HCPs have more knowledge and more positive beliefs about preterm infant feeding, and they prefer and use cup feeding more than Jordanian neonatal HCPs. Physicians have more knowledge and more positive beliefs regarding preterm infant feeding, and they prefer and use cup feeding more than Jordanian neonatal HCPs. Also, more experience leads to more knowledge and more positive beliefs regarding preterm infant feeding, and to more preference and use of cup feeding. And advanced education leads to more knowledge and more positive beliefs regarding preterm infant feeding, and to more preference and use of cup feeding

Cup Feeding in the ICU: The Influence of Health Care Team Knowledge

Background: Preterm birth has significantly increased in the last two decades. Preterm infants lack synchrony and coordination in sucking, swallowing, and breathing necessary for oral feeding. Cup feeding has been identified as a safe alternative for preterm infants who are not able to fully breastfeed, yet the practice is limited. One potential reason this alternative is underutilized is lack of health care provider knowledge regarding cup feeding. Understanding health care provider knowledge will provide information to guide cup feeding education efforts. Purpose: The purpose of this study is to examine the relationship between health care team knowledge and the use of cup feeding in neonatal intensive care units. Methods: A non-experimental cross-cultural correlational design will be used to evaluate study goals. A convenience sample of ~350 neonatal nurses and physicians from US and Jordan will be recruited to complete a web-based survey. Recruitment strategies will include Email, website links, and snowballing. To evaluate health care provider knowledge about cup feeding a questionnaire was developed. The questionnaire includes items asking about demographic data (e.g. Age, ethnicity, occupation, and experience). A 7-point Likert scale ranging from Always to never was used to assess knowledge regarding feeding type (bottle, breast, NGT, and cup). Multivariate Regression analysis will be conducted to examine the relation between health care provider knowledge and cup feeding practices. Regressions will control for potential covariates (e.g., provider age, culture, experience, and education). Findings and Conclusions: Research still in process. Preliminary results will be available by May. Nurses and physicians have the authority to decide which feeding method to use for an infant. In addition, parents are influenced by health care provider advice. Identifying health care provider knowledge of cup feeding can identify misconceptions regarding cup feeding. These findings will lead to educational interventions aimed at improving feeding of preterm infants

Comparative evaluation of dexmedetomidine versus magnesium sulphate on the adequacy of hypotensive anesthesia and post-operative recovery for patients undergoing endoscopic transnasal transsphenoidal pituitary tumor resection

Background: Perioperative use of magnesium sulfate (MgSO4), dexmedetomidine, have been tried in order to provide beneficial clinical effects during general anesthesia (GA). However, few literature discussed it with varying results. Several clinical researches have showed that usage of MgSO4 infusion was associated with a reduction in anesthetic requirement and postsurgical analgesic consumption during GA.Objective: This study aimed to assess the pharmacologic effects of the use of dexmedetomidine and MgSO4 on anesthetic requirement, intra operative haemodynamics stability and postsurgical analgesic effects on the adequacy of hypotensive anesthesia during transsphenoidal resection of pituitary tumours.Patients and methods: A total of 110 cases were enrolled in this prospective study. They were randomized into 2 groups: Group D (55 cases) that was commenced on dexmedetomidine, and group M (55 cases) which received MgSO4Results: The mean values of Boezaart score were significantly decreased in Group D in comparison to group M. In addition, isoflurane and propranolol consumption showed a significant decrease in group D. However, blood loss showed no significant difference when comparing the same groups. Group D expressed significantly longer emergence and extubation times compared to Group M.Conclusion: Dexmedetomidine appears to be superior compared to magnesium sulphate in achieving hypotensive anesthesia during pituitary surgery

Silencing HCV Replication in Its Reservoir

BACKGROUND: HCV infection and its complications are among the leading public health challenges; the emergence of drug-resistant variants are expected to be a major problem. A novel combinatorial small interfering RNA (siRNA) could be a novel triple therapy that could be suitable for genotype 4. Although HCV is a hepatotropic virus, there is reliable evidence about its replication in peripheral blood mononuclear cells (PBMC) of chronically infected patients; these cells act as an extra-hepatic reservoir for viral recurrence and persistence. The patients with HCV-RNA in PBMC showed a significantly lower response to therapy that supports to be one of the factors influencing therapeutic response. Almost all regions of HCV show potential for siRNA target with relative efficiencies of individual siRNA sequences. AIM: This study aims to test the efficacy of siRNA against HCV-4 replication in PBMC in vitro, to introduce an alternative therapeutic option for HCV-4 suitable to eradicate it from both hepatic and extra-hepatic reservoirs. METHODS: Efficacy of synthesised siRNA molecule that targets 5/UTR of domain IIIC within IRES of HCV RNA to eradicate HCV intra-PBMC in vitro was tested and compared with IFN/RBV in vitro, by using both qRT-PCR and western blot. Sixty genotype-4 chronic HCV patients who are naïve for any HCV treatment were enrolled and tested for the presence of HCV intra-PBMC using qRT-PCR before and after siRNA treatment in vitro. RESULTS: Real-time PCR analysis showed a significant reduction of HCV RNA levels after 24hr post-HCV-positive-PBMCs treatment by siRNA with cell vitality reached up to 98%. Besides a complete inhibition of NS5A viral protein expression, that is functionally essential for viral assembly, replication and egress. CONCLUSION: So, Targeting HCV infection using RNA interference technology might be a reliable therapeutic option for chronic HCV patients with HCV minus strand within PBMCs

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Role of the triad of procalcitonin, C-reactive protein, and white blood cell count in the prediction of anastomotic leak following colorectal resections

Purpose: The enhanced recovery after surgery (ERAS) program expedites patient recovery after major surgery. This study aimed to investigate the role of the triad of procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBC) trajectories as a predictive biomarker for the anastomotic leak (AL) after colorectal surgery. Method: Patients who had colorectal anastomosis were prospectively included. Postoperative clinical and laboratory parameters and outcomes were collected and analyzed. The 5-day trajectories of PCT, CRP, and WBC were evaluated. Based on the trajectory of the three biomarkers, we compared patients with and without AL as detected during the first 30 days after surgery using the area under receiver operator characteristic curves (AUC) for logistic estimation. Results: This study included 205 patients, of whom 56% were men and 43.9% were women with a mean age of 56.4 ± 13.1 years. Twenty-two patients (10.7%) had AL; 77.3% underwent surgery, and 22.7% were treated with drainage and antibiotics. Procalcitonin was the best predictor for AL compared to CRP and WBC at three days postoperatively (AUC: 0.84, 0.76, 0.66, respectively). On day 5, a cutoff value of 4.93 ng/mL for PCT had the highest sensitivity, specificity, and negative predictive value. The predictive power of PCT was substantially improved when combined with either CRP or WBC, or both (AUC: 0.92, 0.92, 0.93, respectively). Conclusion: The 5-day trajectories of combined CRP, PCT, and WBC had a better predictive power for AL than the isolated daily measurements. Combining the three parameters may be a reliable predictor of early patient discharge, which would be highly beneficial to ERAS programs

Deep Neural Network for the Prediction of KRAS Genotype in Rectal Cancer

BACKGROUND: KRAS mutation can alter the treatment plan after resection of colorectal cancer. Despite its importance, the KRAS status of several patients remains unchecked because of the high cost and limited resources. This study developed a deep neural network (DNN) to predict the KRAS genotype using hematoxylin and eosin (H&E)-stained histopathological images. STUDY DESIGN: Three DNNs were created (KRAS_Mob, KRAS_Shuff, and KRAS_Ince) using the structural backbone of the MobileNet, ShuffleNet, and Inception networks, respectively. The Cancer Genome Atlas was screened to extract 49,684 image tiles that were used for deep learning and internal validation. An independent cohort of 43,032 image tiles was used for external validation. The performance was compared with humans, and a virtual cost-saving analysis was done. RESULTS: The KRAS_Mob network (area under the receiver operating curve [AUC] 0.8, 95% CI 0.71 to 0.89) was the best-performing model for predicting the KRAS genotype, followed by the KRAS_Shuff (AUC 0.73, 95% CI 0.62 to 0.84) and KRAS_Ince (AUC 0.71, 95% CI 0.6 to 0.82) networks. Combing the KRAS_Mob and KRAS_Shuff networks as a double prediction approach showed improved performance. KRAS_Mob network accuracy surpassed that of two independent pathologists (AUC 0.79 [95% CI 0.64 to 0.93], 0.51 [95% CI 0.34 to 0.69], and 0.51 (95% CI 0.34 to 0.69]; p < 0.001 for all comparisons). CONCLUSION: The DNN has the potential to predict the KRAS genotype directly from H&E-stained histopathological slide images. As an algorithmic screening method to prioritize patients for laboratory confirmation, such a model might possibly reduce the number of patients screened, resulting in significant test-related time and economic savings

30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries.

BACKGROUND There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. METHODS We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. RESULTS Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. CONCLUSIONS BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak

Effect of BMI on safety of bariatric surgery during the COVID-19 pandemic, procedure choice, and safety protocols - An analysis from the GENEVA Study

Background: It has been suggested that patients with a Body Mass Index (BMI) of &gt; 60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach. Methods: We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI -Group I (BMI &lt; 50 kg/m2), Group II (BMI 50-60 kg/m2), and Group III (BMI &gt; 60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed. Results: This study included 7084 patients (5197;73.4 % females). The mean preoperative weight and BMI were 119.49 &amp; PLUSMN; 24.4 Kgs and 43.03 &amp; PLUSMN; 6.9 Kg/m2, respectively. Group I included 6024 (85 %) patients, whereas Groups II and III included 905 (13 %) and 155 (2 %) patients, respectively.The 30-day mortality rate was higher in Group III (p = 0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p = &lt; 0.001). A significantly higher proportion of patients in group III received Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to other groups. Patients with a BMI of &gt; 70 kg/m2 had a 30-day mortality of 7.7 % (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass. Conclusion: The 30-day mortality rate was significantly higher in patients with BMI &gt; 60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection