Category: Nevin Manimala

JMIR Public Health Surveill. 2024 Dec 2;10:e63195. doi: 10.2196/63195.

ABSTRACT

BACKGROUND: Suicide remains a public health priority worldwide with over 700,000 deaths annually, ranking as a leading cause of death among young adults. Traditional research methodologies have often fallen short in capturing the multifaceted nature of suicide, focusing on isolated risk factors rather than the complex interplay of individual, social, and environmental influences. Recognizing these limitations, there is a growing recognition of the value of dynamic simulation modeling to inform suicide prevention planning.

OBJECTIVE: This systematic review aims to provide a comprehensive overview of existing dynamic models of population-level suicide and suicide-related behaviors, and to summarize their methodologies, applications, and outcomes.

METHODS: Eight databases were searched, including MEDLINE, Embase, PsycINFO, Scopus, Compendex, ACM Digital Library, IEEE Xplore, and medRxiv, from inception to July 2023. We developed a search strategy in consultation with a research librarian. Two reviewers independently conducted the title and abstract and full-text screenings including studies using dynamic modeling methods (eg, System Dynamics and agent-based modeling) for suicide or suicide-related behaviors at the population level, and excluding studies on microbiology, bioinformatics, pharmacology, nondynamic modeling methods, and nonprimary modeling reports (eg, editorials and reviews). Reviewers extracted the data using a standardized form and assessed the quality of reporting using the STRESS (Strengthening the Reporting of Empirical Simulation Studies) guidelines. A narrative synthesis was conducted for the included studies.

RESULTS: The search identified 1574 studies, with 22 studies meeting the inclusion criteria, including 15 System Dynamics models, 6 agent-based models, and 1 microsimulation model. The studies primarily targeted populations in Australia and the United States, with some focusing on hypothetical scenarios. The models addressed various interventions ranging from specific clinical and health service interventions, such as mental health service capacity increases, to broader social determinants, including employment programs and reduction in access to means of suicide. The studies demonstrated the utility of dynamic models in identifying the synergistic effects of combined interventions and understanding the temporal dynamics of intervention impacts.

CONCLUSIONS: Dynamic modeling of suicide and suicide-related behaviors, though still an emerging area, is expanding rapidly, adapting to a range of questions, settings, and contexts. While the quality of reporting was overall adequate, some studies lacked detailed reporting on model transparency and reproducibility. This review highlights the potential of dynamic modeling as a tool to support decision-making and to further our understanding of the complex dynamics of suicide and its related behaviors.

TRIAL REGISTRATION: PROSPERO CRD42022346617; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346617.

PMID:39622024 | DOI:10.2196/63195

JMIR Form Res. 2024 Dec 2;8:e51470. doi: 10.2196/51470.

ABSTRACT

BACKGROUND: The implementation of COVID-19 lockdown measures had immediate and delayed psychological effects. From March 27, 2022, to June 1, 2022, the Shanghai government enforced a city-wide lockdown that affected 25 million residents. During this period, mental health services were predominantly provided through digital platforms. However, limited knowledge exists regarding the general population’s intention to use mental health services during this time.

OBJECTIVE: This study aimed to assess the intention of Shanghai residents to use mental health services during the 2022 Shanghai lockdown and identify factors associated with the intention to use mobile mental health services.

METHODS: An online survey was distributed from April 29 to June 1, 2022, using a purposive sampling approach across 16 districts in Shanghai. Eligible participants were adults over 18 years of age who were physically present in Shanghai during the lockdown. Multivariable logistic regression was used to estimate the associations between demographic factors, lockdown-related stressors and experiences, physical and mental health status, and study outcomes-mobile mental health service use intention (mobile applications and WeChat Mini Programs [Tencent Holdings Limited]).

RESULTS: The analytical sample comprised 3230 respondents, among whom 29.7% (weighted percentage; n=1030) screened positive for depression or anxiety based on the 9-item Patient Health Questionnaire or the 7-item Generalized Anxiety Disorder Scale. Less than one-fourth of the respondents (24.4%, n=914) expressed an intention to use any form of mental health services, with mobile mental health service being the most considered option (19.3%, n=728). Only 10.9% (n=440) used digital mental health services during the lockdown. Factors associated with increased odds of mobile mental health service use intention included being female, being employed, being a permanent resident, experiencing COVID-19-related stressors (such as loss of income, food insecurity, and potentially traumatic experiences), and having social and financial support. Individuals with moderate or severe anxiety, as well as those with comorbid anxiety and depression, demonstrated a higher intention to use mobile mental health services. However, individuals with depression alone did not exhibit a significantly higher intention compared with those without common mental disorders.

CONCLUSIONS: Despite a high prevalence of common mental disorders among Shanghai residents, less than one-fourth of the study respondents expressed an intention to use any form of mental health services during the lockdown. Mobile apps or WeChat Mini Programs were the most considered mental health service formats. The study provided insights for developing more person-centered mobile mental health services to meet the diverse needs of different populations.

PMID:39622023 | DOI:10.2196/51470

J Urol. 2024 Dec 2:101097JU0000000000004348. doi: 10.1097/JU.0000000000004348. Online ahead of print.

ABSTRACT

PURPOSE: Post-operative prognostic tools allow for improved prediction of future recurrence risk, patient counselling, assessment of eligibility for adjuvant treatments, and ensure appropriate follow-up surveillance. The purpose of this analysis is to validate existing prognostic models for patients with kidney cancer.

MATERIALS AND METHODS: The Canadian Kidney Cancer Information System (CKCis) is a prospective cohort of patients managed at 14 institutions since January 1, 2011, to present. CKCis was used to assess 15 predictive models for kidney cancer recurrence, 6 for cancer specific mortality, and 4 for all-cause mortality in patients with a solitary, non-metastatic kidney tumor treated with surgery (partial or radical nephrectomy). Discrimination was measured using c-statistics, 5-year calibration plots for calibration, and decision curve analysis at 5-years post-surgery for net-benefit when considering adjuvant therapy.

RESULTS: 7,174 patients were included. For kidney cancer recurrence, c-statistics ranged from 0.62 to 0.83, depending on whether the model was derived, and applied, to all patients without further stratification, specific risk groups, or to specific histological subtypes. Cancer specific mortality models had c-statistics ranging from 0.60 to 0.89 and all-cause mortality models from 0.60 to 0.73. Using decision curve analysis in clear-cell patients, the best models for choosing adjuvant therapy to prevent recurrence and cancer-related death were the Mayo Clinic prediction models.

CONCLUSIONS: Model performance varied considerably with some suitable for clinical use. If using prediction models to select adjuvant therapy, the Mayo Clinic models were best when applied to a large contemporary cohort of Canadian patients.

TAKE HOME MESSAGE: The performance of kidney cancer predictive models varied greatly when applied to a large contemporary cohort. We identified the most accurate models to use when counseling patients about prognosis and adjuvant therapy.

PMID:39622017 | DOI:10.1097/JU.0000000000004348

Neural Comput. 2024 Dec 2:1-33. doi: 10.1162/neco_a_01730. Online ahead of print.

ABSTRACT

Hebbian learning theory is rooted in Pavlov’s classical conditioning While mathematical models of the former have been proposed and studied in the past decades, especially in spin glass theory, only recently has it been numerically shown that it is possible to write neural and synaptic dynamics that mirror Pavlov conditioning mechanisms and also give rise to synaptic weights that correspond to the Hebbian learning rule. In this letter we show that the same dynamics can be derived with equilibrium statistical mechanics tools and basic and motivated modeling assumptions. Then we show how to study the resulting system of coupled stochastic differential equations assuming the reasonable separation of neural and synaptic timescale. In particular, we analytically demonstrate that this synaptic evolution converges to the Hebbian learning rule in various settings and compute the variance of the stochastic process. Finally, drawing from evidence on pure memory reinforcement during sleep stages, we show how the proposed model can simulate neural networks that undergo sleep-associated memory consolidation processes, thereby proving the compatibility of Pavlovian learning with dreaming mechanisms.

PMID:39622007 | DOI:10.1162/neco_a_01730

Pain Physician. 2024 Nov;27(8):E909-E917.

ABSTRACT

BACKGROUND: Since the initial introduction in 1967 of spinal cord stimulation (SCS) in the field of neuromodulation, SCS has been utilized to treat a multitude of chronic pain disorders refractory to both conservative and surgical management. Although efficacious when indicated, SCS has associated risks.

OBJECTIVES: The goals of this study are to explore the trend of rates of SCS complications in 2 approximately equally sized cohorts (1999-2015 and 2016-2021) within a single institution over a 22-year period.

STUDY DESIGN: A retrospective cohort study.

SETTING: A tertiary care academic hospital.

METHODS: A retrospective chart review with pre-existing institutional review board approval was performed on 2 cohorts, one comprising 257 patients between 2016 and 2021 and the other comprising 262 patients between 1999 and 2015, who underwent percutaneous SCS implantation provided by 2 experienced interventional chronic pain specialists. The patients’ demographics and complications were recorded in the REDCAP database. Data were collected on complications of both the biological (allergic/foreign-body reactions, dural puncture/leaks, infections, pain over implantation site, poor wound healing, skin erosions, neurological injuries, and subcutaneous/epidural hematomas) and device-related (electrical leaks, inadequate pain coverage, lead fractures, lead migrations, ligamentum flavum stimulation, recharging/battery failures, and unwanted stimulation) varieties. The chart review included records that started 6 months prior to SCS placement and ended at a period of at least one year of follow-up after placement.

RESULTS: Of the patients studied between 2016 and 2021, the mean age was 58.5 ± 13.0 years, with men representing 46.3% and women 53.7% of the patients studied. Of those studied between 1999 and 2015, the mean age was 50.6 +/- 12.3 years, with men representing 42.4% of the patients and women 57.6%. The overall complication rates were 14.0% (36/257) and 38.9% (102/262) for 2016-2021 and 1999-2015, respectively. The rate of biological complications was nearly 3 times lower in the 2016-2021 group than in the 1999-2015 group (4.3% [11/257] vs 12.2% [32/262], P < 0.001). In the 1999-2015 group, the leading biological complication was infection, the rate of which decreased in the 2016-2021 group (3.4% [9/262] vs 1.9% [5/257], P < 0.42). The rate of device complications was nearly 3 times lower in the 2016-2021 group than in the 1999-2015 group (9.7% [25/257] vs. 26.7% [70/262], P < 0.0001). The leading device complication was inadequate pain coverage (12.2% [32/262] vs 7.4% [19/257], P < 0.08). No serious neurological injury or death occurred in either cohort.

LIMITATIONS: Limitations were inherent to this study’s design, since it was a retrospective cohort study.

CONCLUSION: The rate of SCS-related complications decreased from one group to the next, with the most recent group demonstrating a statistically significant decrease in both device and biological complications. Our results are consistent with SCS literature trends that demonstrate decreasing complications, which may be due to technological advancements in SCS device technology and improved complication mitigation strategies. Further prospective research utilizing multicenter data is needed to better define the overall trend of SCS complications.

PMID:39621991

Pain Physician. 2024 Nov;27(8):E851-E863.

ABSTRACT

BACKGROUND: Exploring factors linked to the outcomes of certain interventional pain management techniques may optimize the selection of candidates for those procedures. Our hypothesis is that factors that influence responses to interventional therapies for chronic low back pain (CLBP) can be identified by analyzing a prospective cohort.

OBJECTIVES: Our main aim is to identify the factors that may be associated with adult patients’ responses to interventional therapies for the treatment of CLBP after 4 weeks of follow-up. Secondary objectives include the development of a predictive model and the establishment of a predictive score.

STUDY DESIGN: The PReTi-Back (Predicting REsponse to interventional Therapies In chronic BACK pain) study is an observational prospective single-center study, employing a nonprobability-sampling method.

SETTING: Our population consists of adult outpatients with CLBP in a chronic pain unit of a tertiary hospital. The procedures we evaluated included epidural steroid injections, medial branch blocks and denervations, dorsal root ganglion blocks, and pulsed radiofrequency.

METHODS: Ratings on the Numeric Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) were measured at the baseline and after 4 weeks of follow-up. The primary outcome of the study was composite and was evaluated at 4 weeks. A positive response to an intervention was defined as the simultaneous occurrence of a decrease of at least 2 points in the NPRS score and a decrease of at least 20% in the ODI score. A predictive model was constructed using logistic regression analysis, which incorporated 14 variables selected in advance. A predictive score was developed based on the odds ratios of the model variables.

RESULTS: Four hundred patients were recruited. Of these patients, 368 completed follow-up, 49 were excluded, and 319 were included in the analysis. The interventional therapies provided a positive response to 85 patients (26.6%) at 4 weeks. Listhesis, radicular compression, and satisfaction with previous interventional therapies were positively associated with the positive response, and their ORs were close to 2. Meanwhile, obesity and persistent spinal pain syndrome type 2 (PSPS-2) had negative associations with the outcome, presenting ORs close to 0.5. The models were statistically significant and exhibited satisfactory goodness of fit. The area under the curve was 0.67 (95% CI, 0.60-0.74). Both models exhibited low sensitivity but high specificity. The synthesis of the prediction score had little impact on its discriminatory capacity.

LIMITATIONS: The subgroup analysis revealed that both listhesis and radicular compression were associated with the response to epidural therapies but not with the response to medial branch therapies. The score was efficient in ruling out those who would not benefit from intervention (scores of 0 or one), but its main limitation was that it was less effective in identifying those who might respond favorably (scores ≥ 2).

CONCLUSIONS: Patients satisfied with previously performed interventional therapies or who exhibit findings of radicular compression or listhesis on imaging show approximately twice the likelihood of experiencing a positive response to short-term IMPT than do patients without those characteristics. Patients who are obese or have PSPS-2 exhibit approximately a 50% lower likelihood of short-term response than do patients without these conditions.

PMID:39621985

Pain Physician. 2024 Nov;27(8):E835-E842.

ABSTRACT

BACKGROUND: Ultrasound-guided 5% dextrose (D5W) hydrodissection provides favorable outcomes for treating peripheral entrapment neuropathies; its safety is well recognized. However, clinical evidence regarding the use of D5W hydrodissection for meralgia paresthetica (MP) is limited. Although corticosteroids are the most common injectates, the possible adverse effects are a big concern.

OBJECTIVE: To compare the efficacy and safety of ultrasound-guided D5W hydrodissection compared to corticosteroid hydrodissection in patients with MP during a 6-month follow-up period.

STUDY DESIGN: A prospective, randomized double-blind, controlled trial.

SETTING: Outpatient clinic at a university hospital.

METHODS: A total of 56 patients with MP were randomly allocated to either a D5W or steroid group in a 1:1 ratio. The patients received one session of ultrasound-guided perineural injection therapy of 10 mL D5W or a corticosteroid solution (1 mL compound betamethasone [1 mL: betamethasone sodium phosphate 5 mg and betamethasone dipropionate 2 mg] mixed with 5 mL 2% lidocaine and 4 mL 0.9% saline).The primary outcomes were Visual Analog Scale (VAS) scores for MP (pain and paresthesia) and global quality of life. The secondary outcomes included self-reported successful clinical response and injection adverse effects. Evaluations were conducted at pretreatment and at one, 3, 4 and 6 months posttreatment.

RESULTS: All patients completed the study. Compared with baseline, both groups exhibited reductions in VAS scores for MP and global quality of life at all follow-up time points, with statistical differences at 3, 4, and 6 months in the D5W group (P < 0.05), as well as those at one, 3, and 4 months in the steroid group (P < 0.05). The D5W group exhibited greater improvement than the steroid group in VAS scores for MP and global quality of life at 4 and 6 months (P < 0.05), and demostrated a more successful clinical response at 6 months (P < 0.05). No adverse effects were reported in the D5W group during the study period, while 6 patients in the steroid group reported an adverse effect.

LIMITATIONS: A longer follow-up period is necessary; the exact mechanism of D5W is not clear.

CONCLUSIONS: Ultrasound-guided perineural injection therapy of D5W is more beneficial than corticosteroid injection for MP at 4 to 6 months posttreatment. Additionally, D5W displays a better safety profile than corticosteroid. Thus, we suggest D5W as a more suitable injectate for patients with MP.

PMID:39621981

Pain Physician. 2024 Nov;27(8):529-535.

ABSTRACT

BACKGROUND: Informed consent is a crucial ethical and legal requirement in medical practice to ensure that patients understand the risks, benefits, and alternatives of medical procedures. Recent advances in multimedia technology have facilitated the exploration of multimedia consent, aiming to enhance patient understanding and satisfaction. Ascertaining that patients have full comprehension of the procedures before opting to undergo them is especially important now that instances of such procedures as lumbar transforaminal epidural steroid injections (TESIs) are increasing.

OBJECTIVES: To determine the effectiveness of multimedia consent forms for lumbar transforaminal steroid injections.

STUDY DESIGN: Randomized clinical trial.

SETTING: Outpatient multidisciplinary pain medicine center of a tertiary hospital.

METHODS: A randomized controlled trial was conducted with 30 patients who received lumbar TESIs for lumbar radiculopathy. Patients were randomly assigned to either the multimedia consent group (Group M) or the conventional paper consent group (Group C). This study evaluated patients’ comprehension of the procedure, their anxiety levels (using the State-Trait Anxiety Inventory short form), and the patients’ post-procedure satisfaction.

RESULTS: Group M showed significantly greater understanding of the procedure and reported lower levels of anxiety than did Group C (P = 0.041; P = 0.03). However, there were no statistically significant differences in post-procedure satisfaction between the groups (P = 0.25). These findings suggest that multimedia consent can effectively improve patient comprehension and reduce anxiety without significantly affecting patient satisfaction.

LIMITATIONS: First, the limited sample size of 30 patients restricts the applicability of our findings to a wider population, suggesting a need for larger studies to better assess the effects of multimedia consent. Second, conducting the study in a single hospital might have introduced bias. Multicenter research may provide a more diverse and accurate evaluation of the efficacy of multimedia consent.

CONCLUSION: This pilot study contributes to the growing evidence supporting the use of multimedia consent to enhance patient understanding and reduce anxiety, marking a promising direction for improving informed consent practices for less invasive procedures, such as lumbar TESIs. Further research is required to fully explore the benefits and limitations of multimedia consent forms in various medical settings.

PMID:39621978

Pain Physician. 2024 Nov;27(8):479-494.

ABSTRACT

BACKGROUND: The effectiveness of mindfulness meditation (MM) for the treatment of fibromyalgia syndrome (FMS) is unknown and needs to be updated.

OBJECTIVE: This study aimed at investigating the effectiveness of MM for the treatment of FMS.

STUDY DESIGN: A systematic review and meta-analysis.

METHODS: A comprehensive search of relevant studies published from the databases’ inception through April 12, 2023 was conducted within the following databases: Cochrane Library, Embase, MEDLINE, PubMed, Clinicaltrials.gov, and PsycINFO. We included randomized controlled trials that reported at least one of the following outcome indicators: the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburg Sleep Quality Index (PSQI), the Beck Depression Inventory (BDI), and the Perceived Stress Scale (PSS). Results are presented in terms of mean difference (MD), supplemented by 95% CIs The I2 statistic assessed heterogeneity across 3 distinct observational time frames. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to appraise the robustness of the evidence.

RESULTS: Ten randomized controlled trials were selected from 1,377 citations (n = 818). Various MM regimens were reported (type of mindfulness, duration, schemes, and ingredients). Among 818 patients, very low to moderate evidence indicated that MM could reduce FIQ in the short-term (MD = -6.20; 95% CI,-8.51 to -3.89; P < 0.05; GRADE: moderate); a lower PSQI score (MD = -1.84; 95% CI, -3.35 to -0.33; P < 0.05; GRADE: very low); a reduce BDI score (MD = -3.26; 95% CI, -5.77 to -0.76; P < 0.05; GRADE: moderate); and a decreased PSS score (MD = -4.85; 95% CI, -8.22 to -1.49; P < 0.05; GRADE: very low). At medium-term follow-up, MM consistently reduced the BDI score (MD = -2.88; 95% CI, -4.98 to -0.79; P < 0.05; GRADE: moderate) and decreased the PSS score (MD = -2.76; 95% CI, -4.82 to -0.70; P < 0.05; GRADE: moderate) but there was no significant difference in FIQ scores (MD = -2.78; 95% CI, -6.32 to 0.76; P > 0.05; GRADE: low) and PSQI scores (MD = -1.28; 95% CI, -3.35 to -0.80; P > 0.05; GRADE: very low). However, at long-term follow-up, MM still reduced FIQ scores (MD = -6.09; 95% CI, -9.01 to -3.16; P < 0.05; GRADE: moderate).

LIMITATIONS: The relatively small sample size and the average quality of the included studies may have introduced biases. The time and method of meditation in the included studies were not completely unified, and there were confounding factors. Additionally, the limited amount of available literature is a challenge. Despite focusing on randomized controlled trials, there is heterogeneity among these studies. Future research should aim for larger, higher-quality studies to address these limitations and provide a more comprehensive understanding of MM’s effectiveness in fibromyalgia management.

CONCLUSIONS: Very low to moderate evidence shows that MM improves quality of life, relieves stress, and relieves insomnia and depression in patients with FMS in the short-term. Notably, the improvement in depression and stress levels continued into the medium-term period. Furthermore, quality of life improvement was discernible at long-term follow-up. This suggests that MM can be used as an adjunct therapy for FMS.International Prospective Register of Systematic Reviews (PROSPERO) Registration Number: CRD42023442356.

PMID:39621973

Pain Physician. 2024 Nov;27(8):469-478.

ABSTRACT

BACKGROUND: Because of its side effects, a morphine replacement has been searched for in the field of postoperative analgesia. Hydromorphone is a derivative of morphine with no active metabolites.

OBJECTIVES: We conducted a meta-analysis of hydromorphone and morphine to compare their clinical effects in postoperative analgesia.

STUDY DESIGN: Systematic review and meta-analysis.

METHODS: The methodological quality of the studies included in this meta-analysis was assessed according to the Cochrane risk-of-bias tool. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were used to evaluate the quality of evidence and recommendation grade for inclusion of randomized controlled trials. The primary outcome was postoperative pain score. Secondary outcomes were severe sedation, nausea, vomiting, and pruritus. The meta-analysis was performed using RevMan 5.4 (The Nordic Cochrane Centre for The Cochrane Collaboration).

RESULTS: Eight randomized controlled trials comprising 833 patients were found. There was no significant difference in pain scores between the hydromorphone and morphine groups at any measured postoperative time point: 8 hours (mean difference [MD] = -0.42; 95%CI, -2.08 to 1.24; P = 0.62); 12 hours (MD = -0.19; 95%CI, -0.62 to 0.24; P = 0.39); 24 hours (MD = -0.22; 95%CI, -0.54 to 0.09; P = 0.17); 36 hours (MD = 0.01; 95%CI, -0.67 to 0.69; P = 0.98) and 48 hours (MD = -0.14; 95%CI, -1.25 to 0.96; P = 0.80). There was no significant difference in the incidence of nausea and vomiting at 24 hours postoperative. The incidence of pruritus at 24 hours postoperative was lower in the hydromorphone group (relative risk = 0.24; 95%CI, 0.09 to 0.66; P = 0.005).

LIMITATIONS: The perioperative multimodal analgesia measures were varying in the included studies, such as different medication doses. The sample size was small for some outcomes and high heterogeneity was observed.

CONCLUSIONS: There was no significant statistical difference in postoperative analgesic effect between hydromorphone and morphine, as well as side effects, including severe sedation, nausea, and vomiting at 24 hours postoperative. However, the incidence of pruritus was lower in the hydromorphone group at 24 hours postoperative.

PMID:39621972