Impact of Personal Protective Equipment on the First-Pass Success of Endotracheal Intubation in the ED: A Propensity-Score-Matching Analysis

Various types and levels of personal protective equipment (PPE) are currently available to protect health-care workers against infectious diseases. However, wearing cumbersome PPE may negatively affect their performance in life-saving procedures. This study aimed to evaluate the impact of wearing extensive PPE, including a powered air-purifying respirator with a loose-fitting hood or an N95 filtering facepiece respirator, on the first-pass success (FPS) rate of endotracheal intubation (ETI) in the emergency department (ED). This study was a single-center, observational before-and-after study of 934 adult (≥18 years old) patients who underwent ETI in the academic ED. The study period was divided into a control period (from 20 January 2019, to 30 September 2019, and from 20 January 2018, to 30 September 2018) and an intervention period (from 20 January 2020, to 30 September 2020). Extensive PPE was not donned during the control period (control group, n = 687) but was donned during the intervention period (PPE group, n = 247). The primary outcome was the FPS rate. We used propensity score matching between the PPE and control groups to reduce potential confounding. Propensity score matching identified 247 cases in the PPE group and 492 cases in the control group. In the matched cohort, no significant difference was found in the FPS rate between the PPE and control groups (83.8% (n = 207) vs. 81.9% (n = 403); p = 0.522). In multivariable analysis, wearing PPE was not associated with the FPS rate (adjusted odds ratio, 0.90; 95% confidence interval, 0.57–1.40; p = 0.629) after adjusting for the level of the intubator (junior resident, senior resident, or emergency medicine (EM) specialist). In conclusion, the FPS rate is not significantly affected by wearing extensive PPE in the ED.

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Impact of Celiac Plexus Neurolysis on Survival in Patients with Unresectable Pancreatic Cancer: A Retrospective, Propensity Score Matching Analysis

January 2018 - Pain Physician ◽

10.36076/ppj.2017.e365 ◽

2017 ◽

Vol 3 (20;3) ◽

pp. E357-E365

Author(s):

Dae Hyun Kim

Keyword(s):

Pancreatic Cancer ◽

Propensity Score ◽

Propensity Score Matching ◽

Median Survival ◽

Small Sample ◽

Celiac Plexus ◽

Control Group ◽

Control Groups ◽

Retrospective Design ◽

And Control

Background: Pain caused by pancreatic cancer (PC) is difficult to control. Celiac plexus neurolysis (CPN) can effectively control the pain and reduce the use of opioids. However, the effect of CPN on survival for patients with unresectable PC remains controversial. Objectives: To determine if CPN is associated with survival benefits for these patients. Study Design: Retrospective, observational cohort study. Setting: National Cancer Center in Korea. Methods: The CPN group included patients who were diagnosed with unresectable PC and underwent fluoroscopically guided bilateral CPN (10 mL dehydrated alcohol each side) once between January 1, 2006, and December 31, 2013. Patients with PC who did not undergo CPN were in the control group; for the final control group, 1:1 propensity score (PS) matching was conducted with the CPN group. The main outcome was median survival (PC diagnosis to death) after PS matching, assessed using Kaplan-Meier curves. Results: For the primary overall survival analysis, the CPN and control groups included 110 and 258 patients, respectively. The median survival period was not significantly different between the CPN and control groups (278 vs. 203 days, P = 0.246), even after PS matching (278 vs. 180 days, P = 0.127), or based on time to CPN from diagnosis (≤ 6 vs. > 6 months; 255 vs. 310 days, P = 0.147). Limitations: Retrospective design, small sample size, and inconsistent timing of CPN after the diagnosis date. Conclusion: CPN did not affect survival for patients with unresectable PC. Considering the limitations of the retrospective design, a well-designed prospective design study should be conducted. Key words: Celiac plexus, pancreatic neoplasms, survival, neurolysis, pain, propensity score matching, opioids, cancer

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Impact of intrawound vancomycin powder on prevention of surgical site infection after posterior spinal surgery

Journal of Neurosurgery Spine ◽

10.3171/2020.8.spine20992 ◽

2021 ◽

pp. 1-9

Author(s):

Hiroki Ushirozako ◽

Tomohiko Hasegawa ◽

Yu Yamato ◽

Go Yoshida ◽

Tatsuya Yasuda ◽

...

Keyword(s):

Propensity Score ◽

Spinal Surgery ◽

Control Group ◽

Control Groups ◽

Propensity Score Model ◽

Significant Difference ◽

Surgical Data ◽

Vancomycin Powder ◽

Vancomycin Group ◽

And Control

OBJECTIVESurgical site infection (SSI) after posterior spinal surgery is one of the severe complications that may occur despite administration of prophylactic antibiotics and the use of intraoperative aseptic precautions. The use of intrawound vancomycin powder for SSI prevention is still controversial, with a lack of high-quality and large-scale studies. The purpose of this retrospective study using a propensity score–matched analysis was to clarify whether intrawound vancomycin powder prevents SSI occurrence after spinal surgery.METHODSThe authors analyzed 1261 adult patients who underwent posterior spinal surgery between 2010 and 2018 (mean age 62.3 years; 506 men, 755 women; follow-up period at least 1 year). Baseline and surgical data were assessed. After a preliminary analysis, a propensity score model was established with adjustments for age, sex, type of disease, and previously reported risk factors for SSI. The SSI rates were compared between patients with intrawound vancomycin powder treatment (vancomycin group) and those without (control group).RESULTSIn a preliminary analysis of 1261 unmatched patients (623 patients in the vancomycin group and 638 patients in the control group), there were significant differences between the groups in age (p = 0.041), body mass index (p = 0.013), American Society of Anesthesiologists classification (p < 0.001), malnutrition (p = 0.001), revision status (p < 0.001), use of steroids (p = 0.019), use of anticoagulation (p = 0.033), length of surgery (p = 0.003), estimated blood loss (p < 0.001), and use of instrumentation (p < 0.001). There was no significant difference in SSI rates between the vancomycin and control groups (21 SSIs [3.4%] vs 33 SSIs [5.2%]; OR 0.640, 95% CI 0.368–1.111; p = 0.114). Using a one-to-one propensity score–matched analysis, 444 pairs of patients from the vancomycin and control groups were selected. There was no significant difference in the baseline and surgical data, except for height (p = 0.046), between both groups. The C-statistic for the propensity score model was 0.702. In the score-matched analysis, 12 (2.7%) and 24 (5.4%) patients in the vancomycin and control groups, respectively, developed SSIs (OR 0.486, 95% CI 0.243–0.972; p = 0.041). There were no systemic complications related to the use of vancomycin.CONCLUSIONSThe current study showed that intrawound vancomycin powder was useful in reducing the risk of SSI after posterior spinal surgery by half, without adverse events. Intrawound vancomycin powder use is a safe and effective procedure for SSI prevention.

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Effectiveness of Physical Therapy for the Management of Chronic Spine Disorders: A Propensity Score Approach

Physical Therapy ◽

10.1093/ptj/86.3.381 ◽

2006 ◽

Vol 86 (3) ◽

pp. 381-394 ◽

Cited By ~ 10

Author(s):

Janet K Freburger ◽

Timothy S Carey ◽

George M Holmes

Keyword(s):

Physical Therapy ◽

Propensity Score ◽

Short Form ◽

Intervention Group ◽

Control Group ◽

Control Groups ◽

Sf 36 ◽

Spine Disorders ◽

And Control

Abstract Background and Purpose. Evidence on the effectiveness of physical therapy for the management of chronic spine disorders is limited. The purpose of this study was to use a large current database, the National Spine Network database, to assess the effectiveness of physical therapy in the management of chronic spine disorders. Subjects. The participants were people who had spine problems lasting 3 months or longer and who were seen for an initial visit and a follow-up visit (N=4,479) at 1 of 17 US spine centers. Methods. A propensity score approach was used to create a matched sample of participants who received physical therapy (intervention group) and participants who did not receive physical therapy (control group). The 2 groups were similar with regard to more than 50 baseline characteristics. Outcomes were assessed with the Oswestry Disability Index (ODI) and the 36-Item Short-Form Health Survey (SF-36). Results. Both the intervention and control groups improved between the initial and the follow-up visits on ODI scores and on SF-36 physical function, role physical, and bodily pain scores. Although the amount of improvement in the outcome measures was significantly greater for the intervention group than for the control group, the differences were small (3–5 points). When the subgroup of participants who had the greatest propensity for receiving physical therapy was examined, differences in the amount of improvement between the intervention and control groups were larger (5–13 points). Discussion and Conclusion. Physical therapy was effective in the management of chronic spine disorders in participants with the greatest propensity for receiving physical therapy. When the entire sample was considered, differences in the amount of improvement between the intervention and control groups were not clinically relevant. [Freburger JK, Carey TS, Holmes GM. Effectiveness of physical therapy for the management of chronic spine disorders: a propensity score approach.

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Impact of Vitamin C and Thiamine Administration on Delirium-Free Days in Patients with Septic Shock

Journal of Clinical Medicine ◽

10.3390/jcm9010193 ◽

2020 ◽

Vol 9 (1) ◽

pp. 193 ◽

Cited By ~ 1

Author(s):

Jong Eun Park ◽

Tae Gun Shin ◽

Ik Joon Jo ◽

Kyeongman Jeon ◽

Gee Young Suh ◽

...

Keyword(s):

Septic Shock ◽

Propensity Score ◽

Vitamin C ◽

Control Group ◽

Matched Pairs ◽

Control Groups ◽

Icu Delirium ◽

Definition Of ◽

And Control ◽

The Impact

Sepsis is a common cause of delirium in the intensive care unit (ICU). Recently, vitamin C and thiamine administration has been gaining interest as a potential adjunct therapy for sepsis. We investigated the impact of early vitamin C and thiamine administration on ICU delirium-free days among critically ill patients in septic shock. We performed a single-center, retrospective study of patients who visited the emergency department (ED) from January 2017 to July 2018. We categorized patients into a treatment (received vitamin C and thiamine) and control group. We compared delirium-free days within 14 days after ICU admission using propensity score matching. Of 435 patients with septic shock, we assigned 89 propensity score-matched pairs to the treatment and control groups. The median delirium-free days did not differ between treatment (11, interquartile range [IQR] 5–14 days) and control (12, IQR 6–14 days) groups (p = 0.894). Secondary outcomes were not different between the two groups, including delirium incidence and 28-day mortality. These findings were consistent after subgroup analysis for patients who met the sepsis-3 definition of septic shock. Vitamin C and thiamine administration showed no association with ICU delirium-free days among patients in septic shock.

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Efficacy Evaluation of Thymosin Alpha 1 in Non-severe Patients With COVID-19: A Retrospective Cohort Study Based on Propensity Score Matching

Frontiers in Medicine ◽

10.3389/fmed.2021.664776 ◽

2021 ◽

Vol 8 ◽

Author(s):

ChenLu Huang ◽

Ling Fei ◽

Wei Xu ◽

WeiXia Li ◽

XuDong Xie ◽

...

Keyword(s):

Propensity Score ◽

Hospital Stay ◽

Propensity Score Matching ◽

Standard Therapy ◽

Control Group ◽

Thymosin Α1 ◽

Significant Difference ◽

Thymosin Alpha 1 ◽

And Control ◽

Related Mortality

Objective: Thymosin alpha 1 (Thymosin-α1) is a potential treatment for patients with COVID-19. We aimed to determine the effect of Thymosin-α1 in non-severe patients with COVID-19.Methods: We retrospectively enrolled 1,388 non-severe patients with COVID-19. The primary and secondary clinical outcomes were evaluated with comparisons between patients treated with or without Thymosin-α1 therapy.Results: Among 1,388 enrolled patients, 232 patients (16.7%) received both Thymosin-α1 therapy and standard therapy (Thymosin-α1 group), and 1,156 patients (83.3%) received standard therapy (control group). After propensity score matching (1:1 ratio), baseline characteristics were well-balanced between the Thymosin-α1 group and control group. The proportion of patients that progressed to severe COVID-19 is 2.17% for the Thymosin-α1 group and 2.71% for the control group (p = 0.736). The COVID-19-related mortality is 0.54% for the Thymosin-α1 group and 0 for the control group (p = 0.317). Compared with the control group, the Thymosin-α1 group had significantly shorter SARS-CoV-2 RNA shedding duration (13 vs. 16 days, p = 0.025) and hospital stay (14 vs. 18 days, p < 0.001). No statistically significant difference was found between the Thymosin-α1 group and control group in duration of symptoms (median, 4 vs. 3 days, p = 0.843) and antibiotic utilization rate (14.1% vs. 15.2%, p = 0.768).Conclusion: For non-severe patients with COVID-19, Thymosin-α1 can shorten viral RNA shedding duration and hospital stay but did not prevent COVID-19 progression and reduce COVID-19-related mortality rate.

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Comparison of the Treatment Outcome Between Primary Intratympanic Steroid and Salvage Intratympanic Steroid Protocol in Sudden Sensorineural Hearing Loss: Propensity Score Matching Analysis

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2019.00458 ◽

2020 ◽

Vol 63 (6) ◽

pp. 252-258 ◽

Cited By ~ 1

Author(s):

Hee Won Seo ◽

Ha Na Lee ◽

Hyun Woong Jun ◽

Hayoung Byun ◽

Jae Ho Chung ◽

...

Keyword(s):

Hearing Loss ◽

Treatment Outcome ◽

Propensity Score ◽

Propensity Score Matching ◽

Sudden Sensorineural Hearing Loss ◽

Control Group ◽

Systemic Steroid ◽

Hearing Level ◽

Propensity Score Matching Analysis ◽

And Control

Background and Objectives We aimed to compare the treatment outcomes of primary intratympanic steroid (ITS) and the salvage ITS protocol.Subjects and Method We assessed 440 patients with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) from January 2016 to December 2019. Of the 440 patients, 37 patients received ITS only as a primary treatment while other patients received systemic steroid; of those remaining patients, 276 received systemic steroid as well as ITS as a salvage treatment. We performed a 1:2 propensity score matching analysis for both groups using parameters such as the initial hearing level, presence of vertigo, onset of treatment, age, sex, hypertension and diabetes. The rate of hearing recovery was determinied by comparing the matching propensity score between the primary ITS and the control group according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guideline and Siegel’s criteria.Results Of the 440 ISSNHL patients, 28.9% received systemic steroid only and 62.6% of patients were managed with systemic steroid plus salvage ITS. Thirty-seven patients (8.4%) were managed with ITS only. While 36.8% of patients completely recovered, 35.0% did not recover their hearing according to AAO-HNS guideline. The propensity score matching showed that the initial hearing level, age and onset of treatment were not significantly different between the primary ITS and control group. Regarding the treatment outcome, complete recovery rate for the primary ITS group and control group were 29.7% and 33.8%, respectively. Although the recovery rate of the salvage ITS protocol group was higher than that of the primary ITS group, statistical significance was not identified.Conclusion Treatment strategies of primary ITS and salvage ITS protocol did not significantly affect the clinical outcomes of ISSNHL differently.

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Effects of Education on the Use of Personal Protective Equipment for Reduction of Contamination: A Randomized Trial

SAGE Open Nursing ◽

10.1177/2377960820940621 ◽

2020 ◽

Vol 6 ◽

pp. 237796082094062

Author(s):

Jeong Hwa Yeon ◽

Yong Soon Shin

Keyword(s):

Infection Control ◽

Education Program ◽

Personal Protective Equipment ◽

Contaminated Sites ◽

Contaminated Site ◽

Control Group ◽

Protective Equipment ◽

Increased Risk ◽

And Control ◽

Experimental Group

Introduction Accurate doffing personal protective equipment (PPE) is one of the key practices of infection control because of increased risk of infection transmission caused by medical garments or environmental contamination. Objectives The study aimed to develop a reality-based education program and identify its effects on nurses’ knowledge, attitudes, and contamination after PPE doffing. Methods Randomized control group pretest–posttest design. A total of 56 nurses were randomly assigned to experimental ( n = 28) and control ( n = 28) groups. The experimental group underwent a new reality-based education program to improve PPE use. Subsequently, participants were assessed on knowledge of and attitude toward PPE use, as well as number and area of contaminated sites after removing PPE and mask fitting test. Results There were no significant differences in knowledge and attitude to PPE use. The experimental group had significantly fewer contaminated sites than the control group (42 vs. 89), and a significantly lower mean contaminated site area (16.63 ± 24.27 vs. 95.41 ± 117.51 cm2). The tuberculosis mask fitting test success rates were 68% and 50% in the experimental and control groups, respectively, but the difference was not significant. Conclusion The reality-based education on use of PPE helps to reduce contamination and improve performance related to the use of PPE for infection control.

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Acromioplasty rates in patients with shoulder disorders with and without acupuncture treatment: a retrospective propensity score–matched cohort study

Acupuncture in Medicine ◽

10.1177/0964528419895529 ◽

2020 ◽

Vol 38 (4) ◽

pp. 255-263

Author(s):

Gujin Yang ◽

Boyoung Jung ◽

Me-riong Kim ◽

Wonil Koh ◽

Namkwen Kim ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Acupuncture Treatment ◽

Acupuncture Group ◽

Control Group ◽

Matched Cohort ◽

Control Groups ◽

Matched Cohort Study ◽

Shoulder Disorders ◽

And Control

Objective: This retrospective propensity score–matched cohort study aimed to examine the frequency of acromioplasty among patients with shoulder disorders receiving and not receiving acupuncture, based on Korea National Health Insurance Service-National Sample Cohort (NHIS-NSC) data. Methods: We included cases of high-frequency shoulder disorders—adhesive capsulitis, rotator cuff syndrome, shoulder impingement syndrome, and sprain and strain of the shoulder joint—stratified from the Korea NHIS-NSC database between 2002 and 2013; cases were classified into two groups based on a history of acupuncture treatment performed at least twice within 6 weeks (acupuncture group: n = 111,561; control group: n = 71,340). We examined propensity scores and hazard ratios (HRs) for the frequency of acromioplasty, within 2 years of the first treatment or first examination in the acupuncture and control groups, respectively; cumulative survival rates were estimated using Kaplan–Meier survival analysis. Results: Following propensity score matching, no differences were observed between the acupuncture and control groups for variables including sex, age, income and the Charlson comorbidity index. In addition, the incidence rates of acromioplasty within 2 years were lower in the acupuncture group than in the control group (HR 0.264; 95% confidence interval 0.224–0.311). Based on differences in sensitivity analyses for the numbers of acupuncture sessions and treatment duration, the frequency of acromioplasty within 2 years was lower in the acupuncture group than in the control group. Conclusion: This study found that the frequency of acromioplasty was reduced in patients with shoulder disorders who had been treated with acupuncture. Although the findings need to be verified by prospective randomized clinical trials, these results imply that acupuncture may be effective at reducing the incidence rate of shoulder surgery.

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Telemedicine in the emergency department to decrease personal protective equipment use: a before-and-after study

Emergency Medicine Journal ◽

10.1136/emermed-2020-210292 ◽

2020 ◽

pp. emermed-2020-210292

Author(s):

Bart G J Candel ◽

Selma M M Vaes ◽

Egid M van Bree ◽

Sophie M A Groenen ◽

Floor Derkx ◽

...

Keyword(s):

Emergency Department ◽

Personal Protective Equipment ◽

Control Period ◽

Protective Equipment ◽

Intervention Period ◽

Patient Anxiety ◽

Contact Isolation ◽

Before And After ◽

Positive Effect ◽

Before And After Study

BackgroundPersonal protective equipment (PPE) used by healthcare workers was scarce during the COVID-19 pandemic. The aim of this study was to assess whether telemedicine (using iPads) reduced PPE use in emergency department (ED) patients who were treated in contact isolation, and whether telemedicine had a positive effect on patient anxiety and satisfaction.MethodsWe conducted a prospective single centre before-and-after study including ED patients ≥18 years who were treated in contact isolation. PPE use, the Hospital Anxiety Scale and the 15-item Picker Patient Experience Questionnaire were compared between the control period (8 April to 14 April 2020) and intervention period (15 April to 24 April 2020).ResultsWe included 25 patients in each period. PPE use per patient was higher for physicians in the control period (mean 1.7; 95% CI 1.5 to 1.9) compared with the intervention period (mean 1.2; 95% CI 1.0 to 1.3, p<0.01). Total PPE use per patient contact for ED physicians decreased from 42 out of 42 patient contacts in the control period, to 29 out of 66 patient contacts in the intervention period (difference 54.3%; 95% CI 50.1% to 58.6%, p<0.01). Reported anxiety and satisfaction were not significantly different.ConclusionPPE use by physicians can successfully be reduced by using telemedicine in the ED without increasing anxiety or dissatisfaction. This study was a first step to gain experience with telemedicine in the ED which has the potential to reduce PPE use in future pandemics or other patients with an indication for contact isolation.

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Conjugated Linoleic Acid Causes a Marked Increase in Liver α-Tocopherol and Liver α-Tocopherol Transfer Protein in C57BL/6 J Mice

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000007 ◽

2010 ◽

Vol 80 (1) ◽

pp. 65-73 ◽

Cited By ~ 10

Author(s):

Pei-Min Chao ◽

Wan-Hsuan Chen ◽

Chun-Huei Liao ◽

Huey-Mei Shaw

Keyword(s):

Antioxidant Enzymes ◽

Linoleic Acid ◽

Conjugated Linoleic Acid ◽

Thiobarbituric Acid ◽

Control Group ◽

Thiobarbituric Acid Reactive Substances ◽

Control Groups ◽

Protein Levels ◽

Transfer Protein ◽

And Control

Conjugated linoleic acid (CLA) is a collective term for the positional and geometric isomers of a conjugated diene of linoleic acid (C18:2, n-6). The aims of the present study were to evaluate whether levels of hepatic α-tocopherol, α-tocopherol transfer protein (α-TTP), and antioxidant enzymes in mice were affected by a CLA-supplemented diet. C57BL/6 J mice were divided into the CLA and control groups, which were fed, respectively, a 5 % fat diet with or without 1 g/100 g of CLA (1:1 mixture of cis-9, trans-11 and trans-10, cis-12) for four weeks. α-Tocopherol levels in plasma and liver were significantly higher in the CLA group than in the control group. Liver α-TTP levels were also significantly increased in the CLA group, the α-TTP/β-actin ratio being 2.5-fold higher than that in control mice (p<0.01). Thiobarbituric acid-reactive substances were significantly decreased in the CLA group (p<0.01). There were no significant differences between the two groups in levels of three antioxidant enzymes (superoxide dismutase, glutathione peroxidase, and catalase). The accumulation of liver α-tocopherol seen with the CLA diet can be attributed to the antioxidant potential of CLA and the ability of α-TTP induction. The lack of changes in antioxidant enzyme protein levels and the reduced lipid peroxidation in the liver of CLA mice are due to α-tocopherol accumulation.

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