A psychometric evaluation of the Family Decision-Making Self-Efficacy Scale among surrogate decision-makers of the critically ill.

OBJECTIVES: The purpose of this study was to report the psychometric properties, in terms of validity and reliability, of the Unconscious Version of the Family Decision-Making Self-Efficacy Scale (FDMSE). METHODS: A convenience sample of 215 surrogate decision-makers for critically ill patients undergoing mechanical ventilation was recruited from four intensive care units at a tertiary hospital. Cross-sectional data were collected from participants between days 3 and 7 of a decisionally impaired patient's exposure to acute mechanical ventilation. Participants completed a self-report demographic form and subjective measures of family decision-making self-efficacy, preparation for decision-making, and decisional fatigue. Exploratory factor analyses, correlation coefficients, and internal consistency reliability estimates were computed to evaluate the FDMSE's validity and reliability in surrogate decision-makers of critically ill patients. RESULTS: The exploratory factor analyses revealed a two-factor, 11-item version of the FDMSE was the most parsimonious in this sample. Furthermore, modified 11-item FDMSE demonstrated discriminant validity with the measures of fatigue and preparation for decision-making and demonstrated acceptable internal consistency reliability estimates. SIGNIFICANCE OF RESULTS: This is the first known study to provide evidence for a two-factor structure for a modified, 11-item FDMSE. These dimensions represent treatment and palliation-related domains of family decision-making self-efficacy. The modified FDMSE is a valid and reliable instrument that can be used to measure family decision-making self-efficacy among surrogate decision-makers of the critically ill.

Compression Therapy for Keloid Scars: A Systematic Review and Meta-analysis.

Background: Keloid scars have a multitude of treatments with varying success rates. The purpose of this systematic review and meta-analysis is to study the different types of compression therapies used following surgical excision and their recurrence rates. Methods: A literature search was conducted using the following databases: PubMed, Embase, and Cochrane Reviews. The following keywords were used in the search: "keloid" and "compression." The following inclusion criteria were used: (1) identifying lesion must be a keloid and (2) use of any type of compression therapy for keloid scar. Results: A total of 27 articles were included in the final analysis, grouped into three treatment modalities for comparison. The three treatment modalities are (1) surgical excision and compression earring, (2) surgical excision and silicone gel sheeting, and (3) surgical excision, compression earring, and silicone gel sheeting. Based on our analysis, combination treatment with compression earring device and silicone gel sheeting had the lowest recurrence rate when compared with compression earring device or silicone gel alone, but the difference in recurrence rates between the three treatment modalities was not statistically significant. Conclusions: There were too few studies included in each treatment modality with even fewer sample sizes, and there is a need for a greater number of studies with increased sample size to evaluate which therapy is the most efficacious in preventing keloid recurrence following surgical excision.

Association of Psychosocial Symptoms, Blood Pressure, and Menopausal Status in African-American Women.

African-American women have disproportionate rates of hypertension that can be further complicated as they transition through menopause. Stress, coupled with depression and hypertension in perimenopausal African-American women has not been fully explored. This study examines the associations of stress, depression, and social support on systolic blood pressure (SBP) among a sample of 184 perimenopausal African-American women. We used descriptive statistics, Pearson's correlation, and logistic regression to analyze data stratified by menopausal status (perimenopausal or menopausal) and SBP status (<130 mmHg vs. >130 mmHg). Women classified as menopausal reported higher levels of stress and depressive symptoms, and lower levels of social support. Age, body mass index (BMI), health insurance, and perceived health status were significant predictors of SBP in menopausal women. Stress, depression, and social support did not play a role in SBP. It is necessary that future research focus on reducing cardiovascular risk include addressing menopausal health.

Evaluation of the Decisional Fatigue Scale Among Surrogate Decision Makers of the Critically Ill.

Intense emotional distress and impaired information processing have been implicated in reducing a surrogate decision maker's ability to formulate informed health care decisions for a critically ill patient. The heightened intensity of negative emotions, mental effort, and impaired judgment is consistent with the manifestation of decision fatigue. The aim of this article is to describe the validity and reliability of the Decision Fatigue Scale (DFS) among surrogate decision makers of the critically ill. A convenience sample of 101 surrogate decision makers were administered the DFS and a battery of psychosocial instruments at two time points. The DFS was specified as a unidimensional measure with adequate internal consistency (Cronbach's αs = .87, .90) and stability reliability. Discriminant validity was established with measures of emotion regulation, anxiety, and depressive symptoms. The DFS is the first subjective measure of decision fatigue for surrogate decision makers of the critically ill that demonstrates satisfactory psychometric properties.

Diagnostic Accuracy of Sonoelastography in the Non-Invasive Diagnosis of Malignant Breast Cancer Compared to Histopathology as a Gold Standard.

OBJECTIVE: To observe the diagnostic accuracy of elastography in detecting malignant breast lesion taking strain ratio of 4.8 and histopathology as gold standard. STUDY DESIGN: Descriptive cross-sectional study. PLACE AND DURATION OF STUDY: Department of Diagnostic Radiology, from March to September 2015. METHODOLOGY: Atotal of 137 patients aged 20 to 60 years with clinically palpable breast lump of any size for at least one month duration were included in this study. Patients with purely cystic lesions and those on chemotherapy or hormonal therapy were excluded. Each patient was subjected to sonoelastography followed by ultrasound guided trucut biopsy. The strain ratio cut off value of 4.8 was used to differentiate benign from malignant lesion. Consultant histopathologist's report upon the biopsy specimens was obtained. Results of sonoelastography were compared with histopathology reports. RESULTS: Mean age was 38.20 ±10.63 years. The size of the lesion ranged from 2.0 to 6.0 cm, a mean = 3.97 ±1.26 cm. The duration since the lump was noticed ranged from 12 weeks (3 months) to 20 weeks (5 months) with a mean of 15.09 ±2.56 weeks. Forty-one (29.9%) lesions were labelled malignant on sonoelastography while the actual number of malignant lesions was 35 (25.5%) on histopathology. When the results of sonoelastography were cross-tabulated with histopathology results, the number of TP(true positive), FN (false negative), FP(false positive) and TN (True negative) were 31, 4, 10 and 92 cases, respectively. It yielded 88.57% sensitivity, 90.20% specificity, 75.61% positive predictive value, 95.83% negative predictive value, 89.78% accuracy for sonoelastography in the diagnosis of malignant breast lesion taking histopathology as gold standard with an observed prevalence of malignant breast mass to be 25.55%. CONCLUSION: Using a strain ratio of 4.8, sonoelastography was found to be 88.57% sensitive, 90.20% specific, and 89.78% accurate in the diagnosis of malignant breast masses.

Analysis of interleukin-10 gene polymorphisms and hepatitis C susceptibility in Pakistan.

INTRODUCTION: Hepatitis C virus (HCV) commonly causes a chronic infection but few of patients are able to clear the virus naturally. Interleukin-10 (IL-10) is an anti-inflammatory cytokine that can suppress the immune response against HCV. Interindividual variations in IL-10 production are genetically contributed by polymorphisms within the IL-10 promoter region. This study aimed to investigate the association of the IL-10 gene promoter -1082 G/A, -819 C/T, and -592 C/A polymorphisms with HCV infection susceptibility in Pakistani individuals. METHODOLOGY: Eighty-nine chronically infected patients and 99 controls were enrolled in the study. IL-10 (-1,082 G/A, -819 C/T, -592 C/A) genotyping was performed by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). RESULTS: A suggestive evidence of association with hepatitis C was obtained for the IL-10 -819 C/T (-592 C/A) (p: 0.03) promoter polymorphism at the allele level  but not in genotype distribution. The IL-10 -1082 allele showed no association while positive association of GG (p: 0.001) gene and negative association for GA (0.001) gene were observed.  Higher frequencies were observed for GTA (p: 0.02), ACC (p: 0.01) haplotype and GCC/GTA (p: 0.005) diplotype in HCV patients than controls while diplotype GCC/ATA showed protective effect against HCV. CONCLUSIONS: Our findings suggest that different IL-10 gene polymorphisms may lead to an imbalance between the pro-inflammatory and anti-inflammatory cytokine responses which may in turn influence the susceptibility to HCV infection.

Frequency of HEV contamination in sewerage waters in Pakistan.

INTRODUCTION: Enteric viruses, including Hepatitis E virus (HEV), are able to persist under environmental conditions and may cause public health problems by contaminating natural and drinking water resources. Routine procedures for monitoring viruses in water samples have not been established for the water microbiology screening panel. METHODOLOGY: Eighty-six raw sewerage samples were collected from the different regions of Islamabad and Rawalpindi, the twin cities of Pakistan. Samples were concentrated for HEV, using a polyethylene glycol-based method followed by viral RNA extraction using a commercial kit-based method. Reverse transcription polymerase chain reaction (RT-PCR) with HEV specific primers was used for the detection of HEV. RESULTS: The present investigation focused on 86 raw sewerage water samples taken from different locations of drainage outlets of Islamabad and Rawalpindi. After careful experimentation, 35 samples were found to be RT-PCR positive.  Nineteen (44.7%) out of 47 samples from Rawalpindi city were HEV positive while 16 (41.02%) out of 39 samples from Islamabad were HEV positive. All positive samples were found in the highly congested areas. CONCLUSIONS: The high detection rate of HEV in this study shows that HEV circulates at a relatively high frequency in the sewerage waters in Pakistan. This study is the first report on detection of HEV from sewerage waste water from Pakistan and suggests that HEV might be a potent indicator of viral pollution in environmental specimens.