Category: Nevin Manimala

Front Endocrinol (Lausanne). 2024 Nov 18;15:1461103. doi: 10.3389/fendo.2024.1461103. eCollection 2024.

ABSTRACT

INTRODUCTION: Turner syndrome (TS) is associated with significant neuropsychological challenges, and screening is recommended at key transition stages. Our goal was to describe the institutional experience of formal neuropsychological assessments in TS and assess differences by karyotype.

METHODS: Data were abstracted by retrospective chart review of completed assessments between January 1, 2019, and October 31, 2022, referred from the newly established multidisciplinary clinic, and descriptive statistical analyses were presented (SAS V9.4).

RESULTS: Of 114 patients, 38 (33%) had completed neuropsychological assessment at a median age of 11.3 years (IQR 6.5-14.9). Median full-scale IQ (FSIQ) was lower in those with a 45,X karyotype compared with other karyotypes (p = 0.027) but did not meet statistical significance at the adjusted significance level for multiple comparisons. Lower median non-verbal IQ [performance intelligence quotient (PIQ)] relative to verbal IQ (VIQ) was observed. Diagnoses of attention-deficit hyperactivity disorder (ADHD) (26%) and anxiety disorder (26%) were common followed by specific learning disorder (mathematics; 18%) and autism spectrum disorder (16%).

DISCUSSION: The prevalence of neuropsychological abnormalities in our diverse clinic underscores the importance of early and routine neuropsychological testing in TS.

PMID:39624818 | PMC:PMC11608949 | DOI:10.3389/fendo.2024.1461103

Front Endocrinol (Lausanne). 2024 Nov 18;15:1461865. doi: 10.3389/fendo.2024.1461865. eCollection 2024.

ABSTRACT

OBJECTIVE: This study aimed to assess the viability of a multivariate regression model utilizing ultrasound findings and serum markers for predicting thyroid cancer metastasis.

METHODS: A retrospective analysis of 98 thyroid patients admitted from January 2022 to October 2022 was conducted to categorize them into a metastasis group (n=20) and a non-metastasis group (n=78) based on postoperative pathological results. Both groups underwent ultrasound examination and serum marker testing. Correlative analysis was performed to explore the association between various indicators and thyroid cancer metastasis. A multivariate regression model was developed, and receiver operating characteristic (ROC) curves were used to assess the predictive value of ultrasound findings, serum markers, and their combination for thyroid cancer metastasis.

RESULTS: Statistically significant differences were found in the levels of ultrasound findings and serum markers between the two groups. Nodule boundaries, presence or absence of halos, margins, lobulation, capsular invasion, surface smoothness, nodule aspect ratio, uric acid, total cholesterol, triglyceride, and LDL cholesterol levels were predictors of metastasis in thyroid cancer. The AUC value of 0.950 for the prediction of thyroid cancer metastasis by ultrasound signs combined with serologic indicators was significantly higher than 0.728 and 0.711 predicted by ultrasound signs or serologic indicators alone.

CONCLUSION: The multivariate regression model incorporating ultrasound findings and serum markers enhances the predictive accuracy for thyroid cancer metastasis, offering essential guidance for early prediction and intervention in a clinical setting.

PMID:39624817 | PMC:PMC11608942 | DOI:10.3389/fendo.2024.1461865

Cureus. 2024 Dec 1;16(12):e74888. doi: 10.7759/cureus.74888. eCollection 2024 Dec.

ABSTRACT

Introduction Mind The Bleep (MTB) is an online medical education organisation run by United Kingdom-based resident doctors. It represents one of a number of free-open access online medical resources (FOAMed) that have increased in popularity, especially since the COVID-19 pandemic. The surgical team of MTB works to produce high-quality surgical educational resources aimed at early postgraduate doctors. This paper provides an appraisal of the teams’ current methods of teaching and the learning points identified from these. Methods This was a retrospective mixed-method review analysing quantitative and qualitative data sources including website analytics and feedback surveys. Wilcoxon signed-rank tests were used to identify significant differences between pre- and post-session confidence levels in the subject matter. Results A total of 22 online targeted education programmes, with a total of 140 webinars were completed between November 2021 and August 2024. The total live viewership was 6733 participants with a mean of 48.1 per webinar. The total attendance including live and watched later was 10221 participants, with a mean of 73 total viewers per webinar. Of the total viewers, 4714 provided feedback (46.1%). Across all webinar series, we identified a statistically significant increase in participant-rated confidence (p<0.05). Discussion Our ability to produce consistent high-quality content is due to leveraging a near-peer teaching model and recruiting resident doctors as teachers. This method ensures cognitive congruence between participant and educator and provides doctors an opportunity to gain teaching experience. Our social media advertising has ensured wide reach. To the best of our knowledge, we provide the first large-scale breakdown of the work done by an online surgical education organisation. Limitations include a low feedback rate and feedback limited to Kirkpatrick type 1 learner reaction.

PMID:39624814 | PMC:PMC11608416 | DOI:10.7759/cureus.74888

Cureus. 2024 Dec 2;16(12):e74990. doi: 10.7759/cureus.74990. eCollection 2024 Dec.

ABSTRACT

Background The use of automatic external defibrillators (AEDs) by lay rescuers can reduce the time to defibrillation and improve survival in out-of-hospital cardiac arrest (OHCA). AEDs use voice prompts to guide users through the defibrillation process, creating a potential barrier for deaf and hard-of-hearing (HoH) individuals. The objective of this study is to assess familiarity with and concerns regarding AED use among members of these communities. Methods A 19-question Qualtrics survey was distributed to adults in the United States who self-identified as deaf or HoH. The questions included seven demographics, eight yes/no/unsure, three Likert scales, and one multiple-response question. Quantitative analysis was performed using 95% confidence intervals to compare familiarity with and concerns about AED use among deaf, HoH, and combined groups of respondents. Results Of the responses, 500 met the inclusion criteria; 130 (26%) self-identified as deaf, and 370 (74%) self-identified as HoH. Around 460 (92%) were in the 18-40 age group. AED recognition was high among both deaf (90.77%) and HoH (84.59%) respondents, though deaf respondents were less likely than HoH respondents to have seen an AED in a public place (p=0.03) or know how to safely use one (p=0.001). In both the deaf and HoH groups, the top concern regarding AED use was that AEDs were too technical or complicated (61.86% and 56.8%). Of all respondents, 36.4% reported that AEDs were not user-friendly (p=0.034). All participants identified some concerns regarding AED use in emergencies. In addition, 56.15% of deaf and 39.19% of HoH respondents were concerned that AED use is potentially dangerous (p<0.001). There was no statistically significant difference between the two groups in knowing when to use an AED or where to find more information about AEDs. Conclusion Deaf and HoH people have specific concerns about AEDs, including the safety and complexity of operating an AED and the accessibility (user-friendliness). In this study, the deaf population is less familiar with using an AED than the HoH population. Possible interventions to address concerns of the deaf and HoH communities include AED training given in American Sign Language (ASL) and updating AED designs with improved visual and non-verbal directions.

PMID:39624811 | PMC:PMC11611321 | DOI:10.7759/cureus.74990

Pharmacoepidemiol Drug Saf. 2024 Dec;33(12):e70066. doi: 10.1002/pds.70066.

ABSTRACT

PURPOSE: The largest rural outbreak of human immunodeficiency virus (HIV) in the US was centered in Scott County, Indiana, and linked to injection practices involving the opioid Opana ER (oxymorphone extended release [ER] reformulated). We examined supply trends using pharmacy transactions of Opana ER in Scott and all US counties from January 2007 to December 2019.

METHODS: We calculated the monthly morphine milligram equivalents (MME) of Opana ER (and its competitor OxyContin) in pharmacies using the Automation of Reports and Consolidated Orders System (ARCOS) database from the Washington Post. We modeled the MME rate per capita in Scott County and five geographic comparators in seven distinct time periods including the market introduction of abuse deterrent formulations of both drugs and the HIV outbreak period (circa 2014).

RESULTS: After Opana ER introduction, transaction rates surged in Scott County, where annual OxyContin MMEs were already seven-fold higher than Indiana overall (CY2009: 46.8 vs. 6.8 MME/pop., respectively). Immediately after OxyContin’s reformulation, the Opana ER growth rate in Scott County surpassed all geographic comparators modeled (~27 times faster than the US, 1.28 vs. 0.047 MME/pop/month, respectively). By 2012, prior to the outbreak, MMEs from Opana ER almost perfectly replaced the diminishing OxyContin supply. When Opana ER with INTAC was subsequently introduced, pharmacy transactions declined precipitously by nearly 50%, persisting through the HIV outbreak period and market withdrawal.

CONCLUSIONS: Opana ER rapidly supplanted OxyContin in a vulnerable population that was at heightened risk for HIV who subsequently faced an immediate supply shock after its reformulation. Pharmacy transactions are critical for suspicious order monitoring and pharmacovigilance by US and international agencies especially during deleterious supply shocks in legal and illicit drug markets.

PMID:39623517 | DOI:10.1002/pds.70066

Health Qual Life Outcomes. 2024 Dec 2;22(1):104. doi: 10.1186/s12955-024-02316-0.

ABSTRACT

BACKGROUND: To assess fatigue in cancer patients, several patient-reported outcome measures (PROMs) are available that differ in content. To support the selection of suitable measures for specific applications and to evaluate possibilities of quantitative linking, the present study provides a content comparison of common fatigue measures, scales, and item banks. We included the EORTC CAT Core, EORTC QLQ-FA12, EORTC QLQ-C30, FACIT-F, PROMIS Fatigue (Cancer item bank v1.0), Brief Fatigue Inventory (BFI), Multidimensional Fatigue Inventory (MFI-20), Piper Fatigue Scale (PFS-12), and PRO-CTCAE.

METHODS: All items of the included measures were linked to the International Classification of Functioning, Disability and Health (ICF). Additionally, they were categorized as assessing general, physical, emotional, or cognitive fatigue. Descriptive statistics were used to display the contents covered in each measure and to allow for a qualitative comparison.

RESULTS: The measures consist of 160 items in total and covered primarily contents of the ICF components ‘Body functions’, ‘Activities and participation’, and ‘Environmental Factors’. Most ICF codings refer to ‘b1300 Energy level’ (9-67% of the codings per instrument; 47% of all coded content). Within the broad categorization of types of fatigue, most items were classified as general fatigue (33-100% of the codings per instrument; 49% of the overall item pool). While the EORTC CAT Core focuses exclusively on physical and general fatigue, FACIT and BFI additionally assess emotional fatigue. The EORTC QLQ-FA12, PROMIS, MFI-20, and PFS-12 cover all fatigue components, including cognitive fatigue.

DISCUSSION: The review provides an in-depth content comparison of PROMs assessing cancer-related fatigue. This can inform the selection of suitable measures in different clinical contexts. Furthermore, it will inform quantitative analyses to facilitate comparison of scores obtained with different PROMs.

PMID:39623483 | DOI:10.1186/s12955-024-02316-0

Scand J Trauma Resusc Emerg Med. 2024 Dec 2;32(1):122. doi: 10.1186/s13049-024-01297-9.

ABSTRACT

BACKGROUND: Helicopter hoist operations (HHO) are an important option for rescue operations in rugged and challenging terrain. German mid-range mountains are characterized by the versatility of ground conditions, few urban structures, and frequent use for local leisure activities, including the practice of more or less high-risk outdoor sports. This retrospective analysis aims to investigate the incidence of rescue missions in German mid-range mountains requiring HHO. The contributing air rescue bases’ operational tactics and the underlying medical characteristics, such as injury patterns and the provided medical care, are also reported.

METHODS: This study is a retrospective analysis of the documentation of HHO missions carried out at the air rescue bases in Freiburg, Nuremberg, and Bautzen staffed by emergency physicians between 01/2020 and 07/2022. Data was extracted from the German Air Rescue database. To assess the topics of interest, we conducted basic descriptive statistics.

RESULTS: Data selection retrieved 410 HHO-associated rescue missions. A total of 304 datasets, including HHO, were suitable for further statistical processing. Air rescue base Freiburg contributed 152, Nuremberg 63, and Bautzen 89 missions. HHO missions showed an increased frequency in the summer season and from Friday to Sunday. In this collective, 75% of the underlying diagnoses were trauma-associated; in 33% of all patients, traumatic injury of the pelvis or lower limb occurred. 28% of the patients were in a potential or actual life-threatening condition and were scored NACA 4 or higher. The rates of invasive medical treatment, such as endotracheal intubation (5%) or venous access (79%), were considerably higher than in overall emergency missions. In terms of mission tactics and cooperation with mountain rescue services, different approaches of the three air bases resulted in differences regarding first-on-scene rates and time spans.

CONCLUSION: The results show a relevant year-round need to deploy emergency medical expertise to inaccessible terrain in the three regions examined. Detailed analysis showed relevant differences in operational tactics between the three bases and potential for optimization. Simultaneous alerting of the hoist helicopter and reliable and precise coordination with other rescue organizations involved, especially the local mountain rescue service and the rescue coordination center, can help to shorten both the treatment-free interval and the prehospital time for patients in inaccessible terrain.

TRIAL REGISTRATION: The study is registered at DRKS (DRKS00033493).

PMID:39623469 | DOI:10.1186/s13049-024-01297-9

Retrovirology. 2024 Dec 3;21(1):20. doi: 10.1186/s12977-024-00653-y.

ABSTRACT

BACKGROUND: The role of viruses in the development of breast cancer has been a subject of debate and extensive research over the past few decades. Several studies have examined the association between Bovine leukemia virus (BLV) infection and the risk of developing breast cancer; however, their findings have yielded inconsistent results. To address this uncertainty, the purpose of the present study was to conduct a systematic review and meta-analysis to determine any potential association between BLV and breast cancer.

METHODS: The literature search was performed by finding related articles from PubMed, Web of Science, Scopus, EMBASE, and ScienceDirect databases. Statistical analysis was conducted using the meta package in R Studio and Review Manager 5.1. The I² test was used to assess between-study heterogeneity. The Mantel-Haenszel method calculated the pooled odds ratio and its 95% confidence interval. Studies were divided into subgroups for comparison.

RESULTS: The literature search identified a total of 17 studies that were deemed suitable for inclusion in the systematic review. Out of these 17 studies, 12 were used in the subsequent meta-analysis. Combining the data from these eligible studies, we calculated the pooled multi-factor adjusted odds ratio (OR) and a 95% confidence interval (CI). Considering the heterogeneity observed across the studies, the result obtained using the fixed effects model was 2.12 (1.77, 2.54). However, upon removing the six studies that contributed significantly to the heterogeneity, the pooled OR with a 95% CI was recalculated to be 3.92 (2.98, 5.16).

CONCLUSION: The result of this study suggests that BLV infection is statistically associated with Breast cancer.

PMID:39623467 | DOI:10.1186/s12977-024-00653-y

Health Res Policy Syst. 2024 Dec 2;22(1):157. doi: 10.1186/s12961-024-01250-3.

ABSTRACT

BACKGROUND: The phenomenon of growth in drug consumption within the framework of national volume-based procurement (VBP) policy raises speculations about demand release and policy inducing. This study aims to explore the reasons and mechanisms of drug consumption increases following VBP policy from two perspectives.

METHODS: We collected data from the China Drug Supply Information Platform, National Bureau of Statistics and the Joint Procurement Office. Twenty cardiovascular international non-proprietary names (INNs) in the first three VBP batches and 28 observation regions were included, constructing 418 valid INN-region combinations as the unit for analysis. The average monthly consumption volume of VBP cardiovascular drug was assigned as the explained variable. The generalized difference-in-difference method was conducted using the price reduction level and the size of policy assessment task as the policy intensity indicator. Moderating effect model was employed to examine the role of resident’s income level.

RESULTS: Increased cardiovascular drug consumption was observed in 285 (68.18%) INN-region combinations after policy implementation. Under VBP policy, the price reduction level was significantly correlated with drug consumption in total (β = 0.144, p < 0.001), as well as in tertiary hospitals, secondary hospitals and primary healthcare centers (PHCs) (all p-values < 0.05). Resident’s income level negatively moderated the impact of price reduction level on drug consumption in total (β = -0.089, p < 0.001) and in secondary hospitals (β = 0.154, p < 0.001) and PHCs (β = -0.2.9, p < 0.001), rather than in tertiary hospitals (β = -0.079, p > 0.05). The size of policy assessment task was positively associated with drug consumption in total (β = 0.052, p < 0.001), as well as in tertiary hospitals, secondary hospitals and PHCs (all p-values < 0.05).

CONCLUSIONS: Two mechanisms codrive drug consumption increases under VBP policy: first is the improvement of cardiovascular medication access and consumption toward lower-income groups following price reduction, pointing to the fulfillment of unmet needs, and second is policy pressure from supporting assessment measures on hospital drug use, indicating potential overprescribing.

PMID:39623462 | DOI:10.1186/s12961-024-01250-3

BMC Med. 2024 Dec 2;22(1):570. doi: 10.1186/s12916-024-03767-4.

ABSTRACT

BACKGROUND: Understanding the prevalence of diseases and where it is detected and recorded in healthcare settings is important for planning effective prevention and care provision. We examined inequalities in the prevalence of 205 chronic conditions and in the care setting where the related diagnoses were recorded in the English National Health Service.

METHODS: We used data from the Clinical Practice Research Datalink Aurum linked with Hospital Episode Statistics for 12.8 million patients registered with 1406 general practices in 2018. We mapped diagnoses recorded in primary and secondary care in the previous 12 years. We used linear regressions to assess associations of ethnicity, deprivation, and general practice with a diagnosis being recorded in primary care only, secondary care only, or both settings.

RESULTS: 72.65% of patients had at least one diagnosis recorded in any care setting. Most diagnoses were reported only in primary care (62.56%) and a minority only in secondary care (15.24%) or in both settings (22.18%). Black (- 0.08 percentage points (pp)), Asian (- 0.08 pp), mixed (- 0.13 pp), and other ethnicity patients (- 0.31 pp) were less likely than White patients to have a condition recorded. Patients in most deprived areas were 0.27 pp more likely to have a condition recorded (+ 0.07 pp in secondary care only, + 0.10 pp in both primary and secondary care, and + 0.10 pp in primary care only). Differences in prevalence by ethnicity were driven by diagnostic recording in primary care. Higher recording of diagnoses in more deprived areas was consistent across care settings. There were large differences in prevalence and diagnostic recording between general practices after adjusting for patient characteristics.

CONCLUSIONS: Linked primary and secondary care records support the identification of disease prevalence more comprehensively. There are inequalities in the prevalence and setting of diagnostic recording by ethnicity, deprivation, and providers on average across conditions. Further research should examine inequalities for each specific condition and whether they reflect also differences in access or recording as well as disease burden. Improving recording where needed and making national linked records accessible for research are key to understanding and reducing inequalities in disease prevention and management.

PMID:39623457 | DOI:10.1186/s12916-024-03767-4