Category: Nevin Manimala

J Forensic Sci. 2024 Oct 30. doi: 10.1111/1556-4029.15643. Online ahead of print.

ABSTRACT

In forensic handwriting analysis, it is crucial to understand the relative frequencies of findings relevant to the specific author, especially when using statistical methods. These are factored into the likelihoods used to determine the probabilities for the different authorship hypotheses. However, if ad hoc writings are included in the comparison materials, the representation of a comparison writer’s habits can be distorted. An overrepresentation of certain creation time points can be avoided by treating ad hoc series of comparison writing samples as internally homogeneous agglomerates, incorporating only a single value per series into the average relative frequency of a given finding for a comparison writer. Additionally, the proposed approach produces finding counts largely independent of the length of the handwriting sample, which has a positive impact on the efficiency and cost-effectiveness of the expert evaluation.

PMID:39474751 | DOI:10.1111/1556-4029.15643

Chin Med J (Engl). 2024 Oct 30. doi: 10.1097/CM9.0000000000003276. Online ahead of print.

ABSTRACT

BACKGROUND: An evidence gap still exists regarding the efficacy and safety of tegoprazan in Chinese patients with erosive esophagitis (EE) in China. This study aimed to verify the efficacy and safety of tegoprazan vs. esomeprazole in patients with EE in China.

METHODS: This study was a multicenter, randomized, double-blind, parallel, active-controlled, non-inferiority phase III trial of patients with EE randomized 1:1 to tegoprazan 50 mg/day vs. esomeprazole 40 mg/day. This study was conducted in 32 sites between October 24, 2018 and October 18, 2019. The primary endpoint was the cumulative endoscopic healing rate at week 8. The secondary endpoint included endoscopic healing rate at week 4, changes in the reflux disease questionnaire (RDQ) and gastroesophageal reflux disease health-related quality of life (GERD-HRQL) scores, and symptom improvement.

RESULTS: A total of 261 patients were randomized: 132 to the tegoprazan group and 129 to the esomeprazole group. The cumulative endoscopic healing rate at 8 weeks in the tegoprazan group was non-inferior to that of the esomeprazole group (91.1% vs. 92.8%, difference: -1.7, 95% confidence interval [CI]: -8.5, 5.0, P = 0.008). There were no statistically significant differences in the changes in RDQ (total, severity, and frequency) and GERD-HRQL scores between the two groups (all P >0.05). The percentages of days without symptoms, including daytime and nighttime symptoms based on patients’ diaries, were similar between the two groups (all P >0.05). In the tegoprazan and esomeprazole groups, 71.5% (93/130) and 61.7% (79/128) of the participants reported adverse events (AEs), 2.3% and 0 experienced serious AEs, while 70.0% and 60.2% had treatment-emergent AEs, respectively.

CONCLUSION: Tegoprazan 50 mg/day demonstrated non-inferior efficacy in healing EE, symptom improvement, and quality of life, and it has similar tolerability compared with esomeprazole 40 mg/day.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT03615677.

PMID:39474720 | DOI:10.1097/CM9.0000000000003276

Prog Transplant. 2024 Oct 30:15269248241288556. doi: 10.1177/15269248241288556. Online ahead of print.

ABSTRACT

Introduction: Patients are at risk of hospital readmission after kidney and liver transplantation due to the complexity of posttransplant care. Currently, clinical practice relies on providers’ prediction since there is a lack of specific strategies. However, the accuracy of clinicians’ ability to predict readmissions using clinical judgment alone is unknown. Research Question: What is the accuracy of clinicians’ ability to predict readmissions after transplantation using clinical judgment alone? Design: In 2019, clinical providers at a large, urban transplant center were electronically surveyed. Primary surgeons, nephrologists, transplant pharmacists, hepatologists, and nurses were asked, within 24 h of any kidney or liver transplant recipient discharge, to predict whether a patient would be readmitted within 30 days, and the suspected causes of readmission. Prediction accuracy was assessed by sensitivity, specificity, positive and negative predictive value, and F-score. Kappa scores were calculated to assess agreement between transplant surgeons and other providers. Results: Overall, N = 34 unique providers were surveyed about 148 kidney and 63 liver transplant recipients, and 27.0% of kidney recipients and 25.4% of liver recipients were readmitted within 30 days. The positive predictive values were low among clinical providers, ranging from 0.25 to 0.55. Agreements between providers were weak, but higher among kidney transplant providers (range: 0.42-0.44) than for liver transplant providers (range: -0.02-0.26). Conclusion: Clinical judgment alone to predict readmission among transplant recipients may not be sufficient and a combination of clinicians’ predictions, multitiered discharge surveillance strategies and data-based predictive models may better identify high-risk patients and guide interventions to reduce readmission.

PMID:39474702 | DOI:10.1177/15269248241288556

J Palliat Med. 2024 Oct 30. doi: 10.1089/jpm.2024.0252. Online ahead of print.

ABSTRACT

Background: Nurses who provide person-centered care even after death must possess essential competencies to perform their duties effectively. Therefore, it is imperative to develop educational programs to enhance the capabilities of new nurses in care after death. Objective: To develop a care after-death mentoring program that includes an augmented reality (AR) end-of-life experience for new nurses and to describe its effectiveness. Design: A quasi-experimental pre- to post-test design was followed to evaluate program outcomes. Setting/Participants: The participants (n = 18) were nurses with <12 months of experience working at a tertiary general hospital in South Korea. Measurements: A pre-post survey was conducted on comfort in bereavement/end-of-life care, death anxiety, and compassion competency. Data were analyzed using the SPSS program, employing descriptive statistics and paired sample t-tests. Results: Significant improvements were observed in both comfort during bereavement/end-of-life care and compassion competency (t = -8.43, p < 0.001; t = -4.90, p < 0.001). Conclusions: This study demonstrated enhancements in participants’ comfort levels regarding bereavement and end-of-life care, as well as their ability to exhibit compassion after participating in the program. Consequently, it was confirmed that simulation-based care after-death mentoring education utilizing an AR app helped enhance the capabilities of new nurses.

PMID:39474695 | DOI:10.1089/jpm.2024.0252

J Laparoendosc Adv Surg Tech A. 2024 Oct 30. doi: 10.1089/lap.2024.0313. Online ahead of print.

ABSTRACT

Introduction: The sleeve gastrectomy (SG) often requires conversion to Roux-en-Y gastric bypass (RYGB) due to gastroesophageal reflux disorder (GERD). Many postbariatric patients seek body-contouring surgery such as abdominoplasty to remove unwanted skin and fat. Although the number of abdominoplasties performed in postbariatric patients is increasing each year, the number of conversion surgeries is increasing in accordance. This study evaluates the impact of abdominoplasties in patients with prior SG on the development of GERD and the need for conversion to RYGB. Methods: A retrospective study was conducted with 630 patients who underwent conversions from SG to RYGB at our institution between January 2014 and December 2023. Outcomes were stratified for comparison between patients with GERD as an indication for conversion and patients with inadequate weight loss as an indication for conversion. Between the two groups we compared the number of patients with post-SG abdominoplasty and the number of hiatal hernias (HH) seen during conversion surgery. A logistic regression analysis was performed to identify factors independently associated with GERD. Results: There was a statistically significant higher number of abdominoplasties in patients who underwent conversion to RYGB for GERD (29 patients, 8.6%) compared to inadequate weight loss (12 patients, 4.1%), P value .034. However, these patients also had statistically significantly more HH (98 patients, 28.9%) compared to patients with inadequate weight loss as an indication for conversion (46 patients, 15.8%), P value <.001. In the logistic regression comparing these two variables, only the presence of HH seen during surgery was found to be a significant predictor of GERD (odds ratio 2.7, confidence interval 1.7-4.1, P < .001). Conclusion: Our data shows that abdominoplasty surgery does not directly influence the development of GERD in post-SG patients. However, the presence of HH in this population significantly impacts the development of GERD, often necessitating conversion to RYGB.

PMID:39474685 | DOI:10.1089/lap.2024.0313

J Palliat Med. 2024 Oct 30. doi: 10.1089/jpm.2024.0082. Online ahead of print.

ABSTRACT

Background: Palliative care (PC) has been shown to benefit patients with metastatic cancer by managing symptoms, improving quality of life, and facilitating advance care planning. Despite this, PC is often misunderstood and underutilized. Objective: To deepen our understanding of PC barriers seen among the spine metastasis population. Design/Setting: Between March 2021 and August 2022, people with metastatic spine tumors (MSTs) at a multidisciplinary oncology clinic were administered a survey on PC prior to their scheduled appointment. These responses were compared with the Health Information National Trends Survey 5 (HINTS 5), which is a validated survey created by the National Cancer Institute between February and June of 2020. Chi-squared statistical analysis was used. Results: Fifty-six people with MST were compared with 3795 patients from the HINTS 5 database. People with MST reported a significantly higher baseline understanding of PC when compared with the general population (GP) (chi-squared = 34.4, p = <0.0001). People with MST had a higher frequency of disagreement with the statement “PC is equivalent with death” when compared with the GP (chi-squared = 12.8, p = 0.0124). Over 25% of the MST group reported no understanding of PC. Conclusion: MST patients are often referred to PC services due to the extreme symptom burden of their disease. Based on this study, in comparison to the GP, people with MST tended to have a more accurate and well-adjusted perception of the goals and functions of PC. Although reassuring, there remains a high proportion of patients who have no knowledge of PC, and groups erroneously associated PC with hospice status.

PMID:39474683 | DOI:10.1089/jpm.2024.0082

J Cachexia Sarcopenia Muscle. 2024 Oct 30. doi: 10.1002/jcsm.13614. Online ahead of print.

ABSTRACT

BACKGROUND: Although pharmacological effects of SGLT2 inhibitors on the development of frailty and sarcopenia were known, the role of SGLT1 remained less clear. The present study investigated the possible effect of SGLT1 inhibition on these conditions and explored potential mediators.

METHODS: A two-sample Mendelian randomization (MR) analysis was performed to assess the effect of SGLT1 inhibition on frailty index (FI) and low grip strength in individuals aged 60 years and older using both the FNIH and EWGSOP criteria. Subsequently, a two-step MR analysis was conducted to investigate the mediating role of insulin resistance phenotype and identify potential mediators of the effect of SGLT1 inhibition on the FI and low grip strength from 1558 plasma proteins and 1352 metabolites.

RESULTS: Genetically predicted SGLT1 inhibition was associated with decreased FI (β: -0.290 [95% CI: -0.399, -0.181]) and reduced risk of low grip strength in individuals aged 60 years and older under both FNIH (β: -0.796 [95% CI: -1.216, -0.376]) and EWGSOP criteria (β: -0.287 [95% CI: -0.532, -0.041]). The two-step MR analysis demonstrated the role of insulin resistance phenotype in mediating SGTL1 inhibition on alleviating frailty (mediation proportion = 19.56% [95% CI: 8.42%, 30.70%]). After screening, 24 proteins and 16 metabolites were identified as mediators of the impact of SGLT1 inhibition on FI. Additionally, 13 proteins and 16 metabolites were found to mediate the effect of SGLT1 inhibition on low grip strength according to FNIH criteria while 22 proteins and 6 metabolites were shown to mediate the impact of SGLT1 inhibition on low grip strength under EWGSOP criteria.

CONCLUSIONS: SGLT1 inhibition potentially mitigated frailty and sarcopenia through several biological mediators, shedding new light for therapeutic intervention.

PMID:39474649 | DOI:10.1002/jcsm.13614

J Eval Clin Pract. 2024 Oct 30. doi: 10.1111/jep.14227. Online ahead of print.

ABSTRACT

BACKGROUND: Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument have been widely used by scholars around the world to assess the methodological quality of clinical practice guidelines (CPGs). We sought to identify items or domains that are commonly scored low in the assessment, and to systematically review the issues that emerged when evaluators used the AGREE II tool for guideline quality assessment.

METHODS: A systematic search was conducted to identify articles published in medically relevant databases from 2022 to 2023 regarding the use of the AGREE II tool for the assessment of CPGs. We extracted six quality domains and overall quality assessment data of CPGs included in the literature, and processed the data using descriptive statistical analysis, difference analysis, regression analysis, and correlation analysis. A seven-point Likert scale was used to assess the reporting quality of the included articles.

RESULTS: 151 relevant publications were identified, including 2081 guidelines published between 1990 and 2022. The results of the regression analysis showed a statistically significant impact of all domains on overall guideline quality (p < 0.001; R² = 0.777). Domain 1, 2, 3, 4, and 6 scores differed significantly over time (p < 0.001) and were increasing. The score was good for Domain 4 (median 78.00 [IQR: 62.75-89.00]; mean 74.34 [SD 18.85]) and Domain 1 (median 78.00 [IQR: 61.00-90.00]; mean 73.57 [SD 21.12]). Scores were generic for Domain 6 (median 58.33 [IQR: 25.00-83.33]; mean 53.98 [SD 34.13]), Domain 2 (median 53.00 [IQR: 33.30-72.10]; mean 53.30 [SD 24.52]) and Domain 3 (median 51.00 [IQR: 26.02-73.00]; mean 50.44 [SD 27.19]). The score was poor for Domain 5 (median 36.20 [IQR: 20.20-58.32]; mean 40.21 [SD 24.90]). In addition, the quality evaluation results of the included articles showed that 33.1% were evaluated as low and 11.9% as very low.

CONCLUSIONS: AGREE II tools have facilitated the development of methodological quality for CPGs. Although the quality of CPGs has improved over time, some general low-quality problems still exist, and solving these problems will be an effective way for developers to upgrade the quality of guidelines. In addition, addressing critical issues in the evaluation of guidelines to present high-quality study reports would be another way to guide guideline development.

PMID:39474648 | DOI:10.1111/jep.14227

J Holist Nurs. 2024 Oct 30:8980101241291616. doi: 10.1177/08980101241291616. Online ahead of print.

ABSTRACT

Purpose: The study’s purpose was to assess: (1) Students’ perceptions toward mindfulness interventions, and (2) Instructors’ perceptions in implementing mindfulness interventions in their classes. Study design: Descriptive study. Methods: A total of 96 students from the second-degree option and BSN programs in the host institution participated in a mindfulness intervention prior to course activities. The four mindfulness interventions utilized in this study included: music, meditation, guided breathing, and positive affirmation. The data were analyzed using descriptive statistics on postintervention surveys. Findings: The mindfulness intervention was overwhelmingly received by the students and faculty as reflected in the result of the confidential postsurveys. The majority of the students and faculty felt that this mindfulness intervention was worth implementing in their course. Conclusion: The mindfulness intervention can promote students’ feelings of “at ease” and confidence prior to a nursing course activity.

PMID:39474643 | DOI:10.1177/08980101241291616

Environ Health (Wash). 2023 Jun 21;1(1):63-71. doi: 10.1021/envhealth.3c00051. eCollection 2023 Jul 21.

ABSTRACT

Most teenagers experience orthodontic treatment, but we do not know the possible adverse effect of the released microplastics and nanoplastics that are recently categorized as emerging contaminants. Herein, we test the rubber band that has been employed to improve the biting of teeth during the orthodontic process to confirm the release of microplastics and nanoplastics. We improve the characterization of microplastics and nanoplastics by (i) Raman imaging, to extract and map the signal from the scanning spectrum matrix or the hyperspectral matrix and to enhance the signal-to-noise ratio statistically. To effectively extract the signal, (ii) chemometrics such as principal component analysis (PCA) are explored to convert the hyperspectral matrix to an image with an increased certainty. The nonsupervised PCA is intentionally corrected, via (iii) the algebra-based algorithm, to further increase the certainty to image the microplastics and nanoplastics. Once the signal is weak, (iv) an additional algorithm of image reconstruction via deconvolution is developed to average the background noise and smooth the image. By doing so, we estimate that millions of microplastics and nanoplastics are released daily in potential from a rubber band applied in a teenager’s mouth, which might be a big concern. Overall, our approach provides a suitable option to characterize the microplastics and nanoplastics from a complex background.

PMID:39474629 | PMC:PMC11504403 | DOI:10.1021/envhealth.3c00051