Category: Nevin Manimala

J Med Internet Res. 2024 Aug 26;26:e56042. doi: 10.2196/56042.

ABSTRACT

BACKGROUND: No single multimorbidity measure is validated for use in NHS (National Health Service) England’s General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR), the nationwide primary care data set created for COVID-19 pandemic research. The Cambridge Multimorbidity Score (CMMS) is a validated tool for predicting mortality risk, with 37 conditions defined by Read Codes. The GDPPR uses the more internationally used Systematized Nomenclature of Medicine clinical terms (SNOMED CT). We previously developed a modified version of the CMMS using SNOMED CT, but the number of terms for the GDPPR data set is limited making it impossible to use this version.

OBJECTIVE: We aimed to develop and validate a modified version of CMMS using the clinical terms available for the GDPPR.

METHODS: We used pseudonymized data from the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RSC), which has an extensive SNOMED CT list. From the 37 conditions in the original CMMS model, we selected conditions either with (1) high prevalence ratio (≥85%), calculated as the prevalence in the RSC data set but using the GDPPR set of SNOMED CT codes, divided by the prevalence included in the RSC SNOMED CT codes or (2) conditions with lower prevalence ratios but with high predictive value. The resulting set of conditions was included in Cox proportional hazard models to determine the 1-year mortality risk in a development data set (n=500,000) and construct a new CMMS model, following the methods for the original CMMS study, with variable reduction and parsimony, achieved by backward elimination and the Akaike information stopping criterion. Model validation involved obtaining 1-year mortality estimates for a synchronous data set (n=250,000) and 1-year and 5-year mortality estimates for an asynchronous data set (n=250,000). We compared the performance with that of the original CMMS and the modified CMMS that we previously developed using RSC data.

RESULTS: The initial model contained 22 conditions and our final model included 17 conditions. The conditions overlapped with those of the modified CMMS using the more extensive SNOMED CT list. For 1-year mortality, discrimination was high in both the derivation and validation data sets (Harrell C=0.92) and 5-year mortality was slightly lower (Harrell C=0.90). Calibration was reasonable following an adjustment for overfitting. The performance was similar to that of both the original and previous modified CMMS models.

CONCLUSIONS: The new modified version of the CMMS can be used on the GDPPR, a nationwide primary care data set of 54 million people, to enable adjustment for multimorbidity in predicting mortality in people in real-world vaccine effectiveness, pandemic planning, and other research studies. It requires 17 variables to produce a comparable performance with our previous modification of CMMS to enable it to be used in routine data using SNOMED CT.

PMID:39186368 | DOI:10.2196/56042

Ann Ital Chir. 2024;95(4):729-736. doi: 10.62713/aic.3354.

ABSTRACT

AIM: Dental implant placement requires precise angulation for long-term success and optimal restoration function. Therefore, this study explores the potential association between the experience of oral and maxillofacial surgeons and the accuracy of implant angulation, including its relationship to neighboring teeth and other implants.

METHODS: This retrospective study included 80 patients involving dental implants, each assessed through postoperative panoramic X-rays. Computer software was employed to measure the angle between the longitudinal axis of the selected implant and adjacent reference points. An angle less than 180° denoted convergence of the implant, while an angle greater than 180° indicated divergence.

RESULTS: The average angle regarding the implant-tooth relationship on the mesial side was 177.74 ± 6.94 (convergent), while on the distal side, it was 182.39 ± 7.77 (divergent). There were no statistically significant variations in insertion angles between procedures performed by experienced specialists (with over 5 years of expertise) and those performed by residents (with less than 5 years of experience). In comparing implants on the right side of the mouth to those on the left, given that all the surgeons were right-handed, no statistical significance was found for either the mesial reference (177.56 ± 7.44 vs. 178.06 ± 6.04, p = 0.76) or the distal reference (182.01 ± 8.38 vs. 183.15 ± 6.52, p = 0.53). However, a statistically significant difference was identified between the inclinations of implants towards the mesial reference compared to the distal inclinations in both cases (p = 0.005 for the right side and p = 0.004 for the left side).

CONCLUSIONS: In summary, satisfactory axial relationship in implant placement is effectively attained by both oral and maxillofacial surgery specialists and residents. Notably, implants consistently show a mesial inclination, irrespective of the specific side of the mouth. Additional research is needed to uncover the root cause of this inclination bias, aiming to promote the parallel alignment of implants with reference structures.

PMID:39186354 | DOI:10.62713/aic.3354

Ann Ital Chir. 2024;95(4):648-656. doi: 10.62713/aic.3382.

ABSTRACT

AIM: This study aimed to evaluate the hypothesis that the utilization of percutaneous screw guides enhances the precision of screw placement in the surgical fixation of talar fractures.

METHODS: Computed tomography (CT) scans of ankle joints were obtained from 40 healthy adults and 10 cadaveric specimens between April 2019 and August 2020 at Ningbo No. 6 Hospital. The acquired CT data were imported into Materialise Interactive Medical Image Control System (MIMICS) software for processing. Three-dimensional (3D) digital models of the ankle joints were reconstructed, and relevant anatomical parameters were measured. A percutaneous screw guide (PSG) was designed and fabricated to facilitate accurate screw placement in the posterior talar process. Ten eligible cadaveric ankle joints were selected for further analysis and their 3D models were reconstructed using the MIMICS software. Screw trajectory parameters were then measured and analyzed based on these cadaveric models, forming the model group for comparative analyses. Ten cadaveric specimens were utilized in this study, equally divided into two groups: a guider group (n = 5) and a free-hand group (n = 5). In the guider group, talar posterior process screws were inserted using percutaneous screw guidance. In the free-hand group, screws were inserted into the talar posterior process without guidance. Post-operative CT scans were performed on all specimens. The following parameters were quantitatively compared between the two groups: screw trajectories, entry point distances in specimens with preselected screws, entry point distance trajectories in the 3D model, operation time, frequency of fluoroscopic imaging, and number of drilling attempts.

RESULTS: Following the generation of the 3D models from 10 cadavers, a virtual screw was digitally inserted into each model. In the model group, the preselected screw trajectory was oriented towards the medial aspect of the talar neck base, with a cephalad inclination angle (CIA) of 3.1° ± 1.5° in the transverse~plane and a medial diverge angle (MDA) of 12.0° ± 1.4° in the coronal plane. The CIA and MDA of the screw trajectory in the guider group were 2.1° ± 1.7° and 11.2° ± 1.6°, respectively, whereas the CIA and MDA in the free-hand group were 6.0° ± 2.2° and 18.8° ± 1.6°, respectively. Statistical analysis revealed significant differences in both CIA and MDA between the two groups (p < 0.05). Furthermore, the guider group yielded superior outcomes in terms of entry point distance, operation time, fluoroscopic exposure time, and number of drilling attempts compared to the free-hand group (p < 0.05).

CONCLUSIONS: Percutaneous screw guidance can improve the accuracy and safety of the posterior process of the talar screws, which can be feasible for percutaneous fixation. Further studies are required to confirm the efficacy and clinical outcomes of percutaneous screw guidance.

PMID:39186350 | DOI:10.62713/aic.3382

Ann Ital Chir. 2024;95(4):534-541. doi: 10.62713/aic.3416.

ABSTRACT

AIM: Esophageal cancer is a disease with high morbidity and mortality, exploring effective treatment methods is the key to the treatment of this disease. This study aims to compare the clinical efficacy and safety of multi-band mucosectomy (MBM) and endoscopic submucosal dissection (ESD) in the treatment of single early esophageal cancer (EEC) and precancerous lesions, and whether MBM can achieve better clinical effect as an effective treatment method.

METHODS: The clinical data of 70 patients with EEC and precancerous lesions who were treated with MBM and ESD in the Fourth Affiliated Hospital of China Medical University from May 2021 to May 2023 and could be followed up were retrospectively analyzed. They were divided into two groups according to different treatment methods: MBM group (31 cases) and ESD group (39 cases). The general data, perioperative conditions, endoscopic treatment effect and pathological results of the two groups were compared.

RESULTS: The duration of endoscopic treatment in MBM group was shorter than that in ESD group [36 (25~39) min vs 46 (41~57) min, p < 0.05], and there was no significant difference in the intraoperative bleeding rate between the two groups (12.90% vs 7.69%, p > 0.05). There was no significant difference in the rate of intraoperative perforation between the two groups (3.23% vs 7.69%, p > 0.05), and the hospitalization time in MBM group was shorter than that in ESD group [5 (4~7) days vs 8 (7~12) days, p < 0.05]. The hospitalization cost was less [2535 (2423~2786) dollars vs 4485 (3858~5794) dollars, p < 0.05]. No postoperative bleeding occurred in both groups. There was no statistically significant difference in postoperative stenosis rate between MBM group and ESD group (3.23% vs 12.82%, p > 0.05), and no statistically significant difference in postoperative local recurrence rate (12.90% vs 5.13%, p > 0.05). There was no significant difference in the rate of additional surgery (9.68% vs 2.56%, p > 0.05). The en bloc resection rate of MBM group was lower than that of ESD group (77.42% vs 97.44%, p < 0.05), but there was no significant difference in the complete resection rate between the two groups (87.10% vs 97.44%, p > 0.05). The postoperative pathological results of MBM group showed 13 cases of low-grade intraepithelial neoplasia (LGIN), 11 cases of high-grade intraepithelial neoplasia (HGIN), and 7 cases of canceration, while the postoperative pathological results of ESD group showed 10 cases of LGIN, 14 cases of HGIN, and 15 cases of canceration, with no statistical significance (p > 0.05).

CONCLUSIONS: MBM and ESD are effective methods for the treatment of EEC and precancerous lesions. MBM has the advantages of short hospital stay, quick recovery and low cost. However, compared with MBM, ESD can improve the complete resection rate of the lesion, avoid the occurrence of positive incisal margin, and reduce the risk of secondary treatment and additional surgery.

PMID:39186346 | DOI:10.62713/aic.3416

Ann Ital Chir. 2024;95(4):699-707. doi: 10.62713/aic.3459.

ABSTRACT

AIM: Patients with permanent colostomy need continuous nursing management measures. Therefore, this study aimed to investigate the impact of discharge planning combined with “Internet home ostomy care platform” on post-discharge complications, self-management abilities, quality of life, and satisfaction of patients with permanent colostomy after rectal cancer surgery.

METHODS: This retrospective analysis included 72 rectal cancer patients who underwent permanent colostomy in Zhejiang Provincial People’s Hospital between January 2021 and December 2021. Patients receiving routine nursing management were included in the control group (n = 36), and those receiving discharge planning combined with “Internet home ostomy care platform” were included in the study group (n = 36). We collected baseline data, complication rate, self-management behavior questionnaire for Chinese enterostomy patients (SBQ-CEP), and Chinese version of the City of Hope Quality of Life-Ostomy Questionnaire (COH-QOL-OQ) and Medical Experience Scale for Outpatient Care of Enterostomy (MES-OCE) score. The complication rate, self-management ability, quality of life, and satisfaction of the two groups were statistically compared and analyzed.

RESULTS: The study group demonstrated significantly higher medical compliance behavior, dietary behavior, symptom management behavior, psychosocial behavior, information management behavior scores, and SBQ-CEP total scores compared to the control group six months after discharge (p < 0.05). However, the study group showed a significantly lower incidence of complications than the control group at 1 week, 2 weeks, 1 month, 3 months, and 6 months after discharge (p < 0.05). Furthermore, the study group demonstrated significantly lower psychological well-being, physical well-being, spiritual well-being, social well-being scores, and COH-QOL-OQ total scores compared to the control group 6 months after discharge (p < 0.05). Additionally, the study group indicated significantly higher environment and process, service attitude, health guidance, diagnosis and treatment effect, overall evaluation of treatment experience scores, and MES-OCE total scores compared to the control group 6 months after discharge (p < 0.05).

CONCLUSIONS: Discharge planning combined with “Internet home ostomy care platform” can effectively reduce the risk of complications in patients with permanent colostomy after rectal cancer surgery. It improves patients’ self-management abilities, quality of life, and satisfaction. This finding provides an ongoing guarantee for the quality of rehabilitation at home for patients with permanent colostomy.

PMID:39186342 | DOI:10.62713/aic.3459

Ann Ital Chir. 2024;95(4):435-447. doi: 10.62713/aic.3511.

ABSTRACT

AIM: Complex anal fistula poses a significant challenge for anorectal surgeons due to its high risks of recurrence and incontinence. A sphincter-preserving procedure named endorectal advancement flap (ERAF) is gradually being applied to clinical practice. Therefore, this meta-analysis aims to evaluate the efficacy and safety of ERAF in managing anal fistula.

METHODS: We searched PubMed, Embase, Cochrane, and Web of Science databases for relevant manuscripts published from 29 August 2003 to 29 August 2023. Among these studies, outcomes included healing rate, recurrence rate, incontinence rate, and complications. Furthermore, the quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS) and the Cochrane risk-of-bias tool. The heterogeneity was determined using the chi-squared test and I2 statistic. A random effects model was applied if significant heterogeneity (p < 0.05 and I2 > 50%) was observed. Sensitivity analysis was conducted by excluding studies with a high risk of bias.

RESULTS: Thirty-eight studies were included in the present analysis, involving 1559 participants. The pooled healing rate and recurrence rate of ERAF were 65.5% (95% confidence intervals (CI): 57.6%-73.4%) and 19.6% (95% CI: 14.8%-24.4%), respectively. The pooled incontinence rate was 10.6% (95% CI: 6.0%-15.1%). According to the subgroup analysis, the healing rate, recurrence rate, and incontinence rate of ERAF for fistula associated with inflammatory bowel disease (IBD) were 53.9% (95% CI: 38.1%-69.7%), 32.6% (95% CI: 21.3%-43.8%), and 2.8% (95% CI: 0%-10.6%), respectively. For patients without IBD, the healing rate, recurrence rate, and incontinence rate of ERAF were 70.6% (95% CI: 63.9%-77.4%), 15.7% (95% CI: 9.9%-21.5%), and 16.5% (95% CI: 8.1%-24.9%), respectively. We observed that bleeding, local infection or abscess, flap dehiscence, and haematomas were the common complications, with incidences of 2.2% (95% CI: 0%-4.5%), 9.5% (95% CI: 4.7%-14.4%), 10.4% (95% CI: 0.0%-21.6%), and 12.4% (95% CI: 0%-27.6%), respectively.

CONCLUSIONS: ERAF may be an optional treatment for anal fistula from the perspective of effectiveness and safety.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42023451451.

PMID:39186335 | DOI:10.62713/aic.3511

Ann Ital Chir. 2024;95(4):552-560. doi: 10.62713/aic.3546.

ABSTRACT

AIM: Minimally invasive spinal trauma surgery includes percutaneous pedicle screw fixation and miniature open anterolateral retractor-based approaches, which can improve surgical outcomes by reducing blood loss, operative time, and postoperative pain. Therefore, this study aimed to evaluate the effect of minimally invasive surgery on pain scores, functional recovery, and postoperative complications in patients with spinal trauma.

METHODS: This retrospective study included 100 spinal trauma patients treated in Suzhou Hospital of Integrated Traditional Chinese and Western Medicine between May 2019 and May 2022. Patients who underwent traditional open surgery were included in the traditional group, and those who received percutaneous pedicle screw internal fixation combined with posterior minimally invasive small incision decompression were included in the research group, each comprising 50 patients. The effectiveness of these two surgical approaches was determined by assessing their outcome measures, including surgery-related indices, postoperative pain, spinal morphology, functional recovery, and postoperative complications.

RESULTS: Minimally invasive surgery was associated with significantly shorter surgical wounds, length of hospital stay, operative time, and postoperative time-lapse before off-bed activity, and less intraoperative hemorrhage volume and postoperative drainage volume compared to open surgery (p < 0.001). Compared to open surgery, patients with minimally invasive surgery showed significantly lower visual analogue scale (VAS) scores at 3 days, 3 months, and 6 months after surgery and lower Oswestry dysfunction index (ODI) at 7 days and 3 months after surgery (p < 0.05). Furthermore, the difference in the spine morphology between the two arms did not achieve statistical significance (p > 0.05). Additionally, minimally invasive surgery resulted in a significantly lower incidence of postoperative complications than open surgery (p < 0.05).

CONCLUSIONS: Minimally invasive surgery causes less surgical damage for patients with spinal trauma, improves surgery-related indexes, alleviates postoperative pain, and provides better morphological and functional recovery of the spine.

PMID:39186331 | DOI:10.62713/aic.3546

J Med Internet Res. 2024 Aug 26;26:e46936. doi: 10.2196/46936.

ABSTRACT

BACKGROUND: The presence of bias in artificial intelligence has garnered increased attention, with inequities in algorithmic performance being exposed across the fields of criminal justice, education, and welfare services. In health care, the inequitable performance of algorithms across demographic groups may widen health inequalities.

OBJECTIVE: Here, we identify and characterize bias in cardiology algorithms, looking specifically at algorithms used in the management of heart failure.

METHODS: Stage 1 involved a literature search of PubMed and Web of Science for key terms relating to cardiac machine learning (ML) algorithms. Papers that built ML models to predict cardiac disease were evaluated for their focus on demographic bias in model performance, and open-source data sets were retained for our investigation. Two open-source data sets were identified: (1) the University of California Irvine Heart Failure data set and (2) the University of California Irvine Coronary Artery Disease data set. We reproduced existing algorithms that have been reported for these data sets, tested them for sex biases in algorithm performance, and assessed a range of remediation techniques for their efficacy in reducing inequities. Particular attention was paid to the false negative rate (FNR), due to the clinical significance of underdiagnosis and missed opportunities for treatment.

RESULTS: In stage 1, our literature search returned 127 papers, with 60 meeting the criteria for a full review and only 3 papers highlighting sex differences in algorithm performance. In the papers that reported sex, there was a consistent underrepresentation of female patients in the data sets. No papers investigated racial or ethnic differences. In stage 2, we reproduced algorithms reported in the literature, achieving mean accuracies of 84.24% (SD 3.51%) for data set 1 and 85.72% (SD 1.75%) for data set 2 (random forest models). For data set 1, the FNR was significantly higher for female patients in 13 out of 16 experiments, meeting the threshold of statistical significance (-17.81% to -3.37%; P<.05). A smaller disparity in the false positive rate was significant for male patients in 13 out of 16 experiments (-0.48% to +9.77%; P<.05). We observed an overprediction of disease for male patients (higher false positive rate) and an underprediction of disease for female patients (higher FNR). Sex differences in feature importance suggest that feature selection needs to be demographically tailored.

CONCLUSIONS: Our research exposes a significant gap in cardiac ML research, highlighting that the underperformance of algorithms for female patients has been overlooked in the published literature. Our study quantifies sex disparities in algorithmic performance and explores several sources of bias. We found an underrepresentation of female patients in the data sets used to train algorithms, identified sex biases in model error rates, and demonstrated that a series of remediation techniques were unable to address the inequities present.

PMID:39186324 | DOI:10.2196/46936

J Med Internet Res. 2024 Aug 26;26:e54034. doi: 10.2196/54034.

ABSTRACT

BACKGROUND: Social media platforms are increasingly used to recruit patients for clinical studies. Yet, patients’ attitudes regarding social media recruitment are underexplored.

OBJECTIVE: This mixed methods study aims to assess predictors of the acceptance of social media recruitment among patients with hepatitis B, a patient population that is considered particularly vulnerable in this context.

METHODS: Using a mixed methods approach, the hypotheses for our survey were developed based on a qualitative interview study with 6 patients with hepatitis B and 30 multidisciplinary experts. Thematic analysis was applied to qualitative interview analysis. For the cross-sectional survey, we additionally recruited 195 patients with hepatitis B from 3 clinical centers in Germany. Adult patients capable of judgment with a hepatitis B diagnosis who understood German and visited 1 of the 3 study centers during the data collection period were eligible to participate. Data analysis was conducted using SPSS (version 28; IBM Corp), including descriptive statistics and regression analysis.

RESULTS: On the basis of the qualitative interview analysis, we hypothesized that 6 factors were associated with acceptance of social media recruitment: using social media in the context of hepatitis B (hypothesis 1), digital literacy (hypothesis 2), interest in clinical studies (hypothesis 3), trust in nonmedical (hypothesis 4a) and medical (hypothesis 4b) information sources, perceiving the hepatitis B diagnosis as a secret (hypothesis 5a), attitudes toward data privacy in the social media context (hypothesis 5b), and perceived stigma (hypothesis 6). Regression analysis revealed that the higher the social media use for hepatitis B (hypothesis 1), the higher the interest in clinical studies (hypothesis 3), the more trust in nonmedical information sources (hypothesis 4a), and the less secrecy around a hepatitis B diagnosis (hypothesis 5a), the higher the acceptance of social media as a recruitment tool for clinical hepatitis B studies.

CONCLUSIONS: This mixed methods study provides the first quantitative insights into social media acceptance for clinical study recruitment among patients with hepatitis B. The study was limited to patients with hepatitis B in Germany but sets out to be a reference point for future studies assessing the attitudes toward and acceptance of social media recruitment for clinical studies. Such empirical inquiries can facilitate the work of researchers designing clinical studies as well as ethics review boards in balancing the risks and benefits of social media recruitment in a context-specific manner.

PMID:39186322 | DOI:10.2196/54034

Aging Ment Health. 2024 Aug 26:1-8. doi: 10.1080/13607863.2024.2394591. Online ahead of print.

ABSTRACT

OBJECTIVES: Various dementia risk scores exist that assess different factors. We investigated the association between the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score and modifiable risk factors in the Lifestyle for Brain Health (LIBRA) score in a German population at high risk of Alzheimer’s disease.

METHOD: Baseline data of 807 participants of AgeWell.de (mean age: 68.8 years (SD = 4.9)) were analysed. Stepwise multivariable regression was used to examine the association between the CAIDE score and additional risk factors of the LIBRA score. Additionally, we examined the association between dementia risk models and cognitive performance, as measured by the Montreal Cognitive Assessment.

RESULTS: High cognitive activity (β = -0.016, p < 0.001) and high fruit and vegetable intake (β = -0.032, p < 0.001) correlated with lower CAIDE scores, while diabetes was associated with higher CAIDE scores (β = 0.191; p = 0.032). Although all were classified as high risk on CAIDE, 31.5% scored ≤0 points on LIBRA, indicating a lower risk of dementia. Higher CAIDE and LIBRA scores were associated with lower cognitive performance.

CONCLUSION: Regular cognitive activities and increased fruit and vegetable intake were associated with lower CAIDE scores. Different participants are classified as being at-risk based on the dementia risk score used.

PMID:39186318 | DOI:10.1080/13607863.2024.2394591