Category: Nevin Manimala

BMJ Open. 2024 Aug 19;14(8):e082802. doi: 10.1136/bmjopen-2023-082802.

ABSTRACT

INTRODUCTION: Traumatic brain injury (TBI) and spinal cord injury (SCI) are both major contributors to permanent disability globally, with an estimated 27 million new cases of TBI and 0.93 million new cases of SCI globally in 2016. In Australia, the National Disability Insurance Scheme (NDIS) provides support to people with disability. Reports from the NDIS suggest that the cost of support for people with TBI and SCI has been increasing dramatically, and there is a lack of independent analysis of the drivers of these increases. This data linkage seeks to better understand the participant transition between rehabilitation hospitals and the NDIS and the correlation between functional independence in rehabilitation and resource allocation in the NDIS.

METHODS AND ANALYSIS: This is a retrospective, population-based cohort study using Australia-wide NDIS participant data and rehabilitation hospital episode data. The linked dataset provides a comparison of functional independence against which to compare the NDIS resource allocation to people with TBI and SCI. This protocol outlines the secure and separated data linkage approach employed in linking partially identified episode data from the Australasian Rehabilitation Outcomes Centre (AROC) with identified participant data from the NDIS. The linkage employs a stepwise deterministic linkage approach. Statistical analysis of the linked dataset will consider the relationship between the functional independence measure score from the rehabilitation hospital and the committed funding supports in the NDIS plan. This protocol sets the foundation for an ongoing data linkage between rehabilitation hospitals and the NDIS to assist transition to the NDIS.

ETHICS AND DISSEMINATION: Ethics approval is from the Macquarie University Human Research Ethics Committee. AROC Data Governance Committee and NDIS Data Management Committee have approved this project. Research findings will be disseminated to key stakeholders through peer-reviewed publications in scientific journals and presentations to clinical and policy audiences via AROC and NDIS.

PMID:39160099 | DOI:10.1136/bmjopen-2023-082802

BMJ Open. 2024 Aug 19;14(8):e080794. doi: 10.1136/bmjopen-2023-080794.

ABSTRACT

INTRODUCTION: Complementary feeding is considered appropriate when introduced timely at 6 months of age, and where it fulfils the minimum meal frequency, minimum dietary diversity and minimum acceptable diet. Sufficient evidence is available on the different individual indicators of appropriate complementary feeding.

OBJECTIVE: This study was conducted to assess the prevalence and determinants of appropriate complementary feeding practices among children aged 6-23 months in Tigray, Northern Ethiopia.

DESIGN AND SETTING: A community-based cross-sectional study was conducted in 52 districts of Tigray.

PARTICIPANTS: A total of 5321 children aged 6-23 months were included using stratified two-stage random sampling.

RESULTS: Approximately 19% of children received appropriate complementary feeding. Maternal residence in urban areas (adjusted OR (AOR) 1.26; 95% CI 1.062 to 1.489), maternal education (AOR 1.34; 95% CI 1.111 to 1.611), antenatal care (ANC) visits (AOR 1.75; 95% CI 1.343 to 2.281), household food security (AOR 2.81; 95% CI 2.367 to 3.330) and provision of colostrum to newborns (AOR 1.76; 95% CI 1.139 to 2.711) were found predictors of appropriate complementary feeding. Moreover, children in the 12-17 and 18-23 months age groups were 1.3 (AOR 1.30; 95% CI 1.083 to 1.551) and 1.7 (AOR 1.73; 95% CI 1.436 to 2.072) times more likely to receive appropriate complementary feeding respectively, compared with children aged 6-11 months.

CONCLUSIONS: Appropriate complementary feeding practices among children aged 6-23 months remain unacceptably low in Tigray. Recommendations to improve nutrition outcomes include counselling on age-appropriate complementary feeding, education for girls and women, targeting families through food security initiatives, provision of nutrition education on appropriate complementary feeding practices during ANC visits, supporting mothers to initiate breastfeeding within the first hour of delivery and crafting context-based messaging for rural families.

PMID:39160097 | DOI:10.1136/bmjopen-2023-080794

Stroke Vasc Neurol. 2024 Aug 19:svn-2024-003320. doi: 10.1136/svn-2024-003320. Online ahead of print.

ABSTRACT

OBJECTIVES: Endovascular therapy (EVT) now penetrates the once obscure realm of large infarct core volume acute ischaemic stroke (LICV-AIS). This research aimed to investigate the potential correlation between different anaesthetic approaches and post-EVT outcomes in LICV-AIS patients.

METHODS: Between October 2020 and May 2022, the China ANGEL-Alberta Stroke Programme Early CT Score (ASPECT) trial studied patients with LICV-AIS, randomly assigning them to the best medical management (BMM) or BMM with EVT. This post hoc subgroup analysis categorised subjects receiving BMM with EVT into general anaesthesia (GA) and non-GA groups based on anaesthesia type. We applied multivariable logistic regression to evaluate the relationship between anaesthesia during EVT and patient functional outcomes, as measured by the modified Rankin scale (mRS), in addition to the occurrence of complications. Further adjustment for selection bias was achieved through propensity score matching (PSM).

RESULTS: In total, 230 patients with LICV-AIS were enrolled (GA 84 vs Non-GA 146). No significant difference was observed between the two groups in terms of the proportion of patients who achieved an mRS score of 0-2 at 90 days (27.4% for the GA group vs 31.5% for the non-GA group, p=0.51). However, the GA group had significantly longer median surgical times (142 min vs 122 min, p=0.03). Furthermore, GA was associated with an increased risk of postoperative pneumonia (adjusted OR 2.03, 95% CI 1.04 to 3.98). The results of PSM analysis agreed with the results of the multivariate regression analysis. No significant difference in intracranial haemorrhage incidence or mortality rate was observed between the groups.

CONCLUSION: This post hoc analysis of subgroups of the ANGEL-ASPECT trial suggested that there may be no significant association between the choice of anaesthesia and neurological outcomes in LICV-AIS patients. However, compared with non-GA, GA prolongs the duration of EVT and is associated with a greater postoperative pneumonia risk.

TRIAL REGISTRATION NUMBER: NCT04551664.

PMID:39160092 | DOI:10.1136/svn-2024-003320

RMD Open. 2024 Aug 19;10(3):e004395. doi: 10.1136/rmdopen-2024-004395.

ABSTRACT

OBJECTIVES: To compare the sensitivity of 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) classification criteria against 1997 ACR criteria for systemic lupus erythematosus (SLE), for incident SLE cases in the presumably complete population-based Nor-SLE cohort from Southeast Norway (2.9 million inhabitants).

METHODS: All cases International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) coded as SLE during 2000-2017 were individually reviewed. Those with a confirmed SLE diagnosis by expert clinical assessment were included in the Nor-SLE cohort. Core clinical data were recorded, and the cases were classified according to 2019 EULAR/ACR and 1997 ACR criteria. Juvenile SLE was defined as <16 years at diagnosis and adult SLE was defined as ≥16 years at diagnosis.

RESULTS: We included 737 incident SLE cases (701 adults, 36 juveniles). At diagnosis, 2019 EULAR/ACR criteria were more sensitive than 1997 ACR criteria for adults (91.6% vs 77.3%; p<0.001), but not for juveniles (97.2% vs 88.9%). The 2019 EULAR/ACR counts at diagnosis differed by age group and ethnicity, being higher in young cases and those originating from Asia. From time of diagnosis to study end the fulfilment rate of 2019 EULAR/ACR criteria for the adult cohort increased from 92.5% and 86.5% to 94.6% and 91.0%, respectively, for females and males (mean disease duration of 7.5 years).

CONCLUSION: Showing 92% criteria fulfilment already at time of SLE diagnosis by 2019 EULAR/ACR criteria versus 77% by 1997 ACR criteria, the results from this population-based study suggest that the 2019 EULAR/ACR criteria will achieve its goal of capturing more early-SLE cases for clinical trials.

PMID:39160088 | DOI:10.1136/rmdopen-2024-004395

Int J Gynecol Cancer. 2024 Aug 19:ijgc-2024-005718. doi: 10.1136/ijgc-2024-005718. Online ahead of print.

ABSTRACT

OBJECTIVE: Given limited real-world practice data evaluating the National Comprehensive Cancer Network clinical practice guidelines for possible post-operative chemotherapy omission as a treatment option for patients with stage IC grade 1 endometrioid ovarian carcinoma, this population-based study examined the association between post-operative chemotherapy and overall survival in this tumor group.

METHODS: The National Cancer Institute’s Surveillance, Epidemiology, and End Results program was retrospectively queried. The study population was 1207 patients with stage IC grade 1-3 endometrioid ovarian carcinoma who received primary cancer-directed surgery from 2007 to 2020. Overall survival was assessed with multivariable Cox proportional hazard regression model.

RESULTS: The median age was 52, 54, and 55 years for grade 1, 2, and 3 groups, respectively (p=0.02). Grade 1 and 2 tumors were more common than grade 3 tumors (n=508 (42.1%), n=493 (40.8%), and n=206 (17.1%), respectively). Chemotherapy use rate for grade 1 tumors was lower compared with grade 2-3 tumors (67.9%, 76.5%, and 78.6%, respectively, p<0.001). When nodal evaluation was performed for grade 1 tumors, among patients who did not receive post-operative chemotherapy and among those who did, 5-year overall survival rate exceeded 90% (93.3% and 96.0%, respectively), with statistically non-significant hazard estimates (adjusted hazard ratio (aHR) 1.54, 95% CI 0.63 to 3.73). In contrast, post-operative chemotherapy omission for patients who did not undergo nodal evaluation was associated with decreased overall survival (5-year rates 82.3% vs 96.0%, aHR 5.41, 95% CI 1.95 to 15.06). Results were similar for node-evaluated grade 2 tumors (5-year overall survival rates, 94.6% and 94.4% for node-evaluated post-operative chemotherapy omission and administration, respectively), but not in grade 3 tumors.

CONCLUSION: The results of this population-based study may partially support the current clinical practice guidelines for post-operative chemotherapy omission as a possible option for patients with stage IC grade 1 endometrioid adenocarcinoma of the ovary for those who had lymph node evaluation. Observed data were also supportive for node-evaluated grade 2 tumors, warranting further evaluation.

PMID:39160085 | DOI:10.1136/ijgc-2024-005718

BMJ Health Care Inform. 2024 Aug 19;31(1):e101096. doi: 10.1136/bmjhci-2024-101096.

ABSTRACT

OBJECTIVES: This project aims to determine the feasibility of predicting future critical care bed availability using data-driven computational forecast modelling and routinely collected hospital bed management data.

METHODS: In this proof-of-concept, single-centre data informatics feasibility study, regression-based and classification data science techniques were applied retrospectively to prospectively collect routine hospital-wide bed management data to forecast critical care bed capacity. The availability of at least one critical care bed was forecasted using a forecast horizon of 1, 7 and 14 days in advance.

RESULTS: We demonstrated for the first time the feasibility of forecasting critical care bed capacity without requiring detailed patient-level data using only routinely collected hospital bed management data and interpretable models. Predictive performance for bed availability 1 day in the future was better than 14 days (mean absolute error 1.33 vs 1.61 and area under the curve 0.78 vs 0.73, respectively). By analysing feature importance, we demonstrated that the models relied mainly on critical care and temporal data rather than data from other wards in the hospital.

DISCUSSION: Our data-driven forecasting tool only required hospital bed management data to forecast critical care bed availability. This novel approach means no patient-sensitive data are required in the modelling and warrants further work to refine this approach in future bed availability forecast in other hospital wards.

CONCLUSIONS: Data-driven critical care bed availability prediction was possible. Further investigations into its utility in multicentre critical care settings or in other clinical settings are warranted.

PMID:39160082 | DOI:10.1136/bmjhci-2024-101096

J Clin Pathol. 2024 Aug 19:jcp-2024-209552. doi: 10.1136/jcp-2024-209552. Online ahead of print.

ABSTRACT

AIMS: Diagnosis of IgG4-related ophthalmic disease (IgG4-ROD) rests on the correlation of clinical features, serological testing and histopathology, using internationally accepted diagnostic criteria for objective interpretation; however, several mimickers of IgG4-RD overlap in clinical presentation and histopathology. We assess histopathological features in a series of presumptive IgG4-ROD cases, with emphasis on histopathological mimics and comparison of three IgG4-ROD diagnostic/classification criteria (organ-specific (OS), revised comprehensive diagnostic (RCD) and American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) criteria).

METHODS: The histopathology database was screened for cases with clinical/histopathological suspicion of IgG4-ROD. Slides were reviewed, OS, RCD and ACR/EULAR criteria were applied, and the final clinicopathological diagnosis was recorded.

RESULTS: 37 patients (24 females, 13 males; 19-73 years) were diagnosed as either IgG4-ROD (n=18) or non-IgG4-related disease (n=19). Non-IgG4-related disease group showed elevated serum IgG4 (55.5%), fibrosis (100%), dense lymphoplasmacytic inflammation (92.8%), with an increase in tissue IgG4+plasma cells (57.1%) and elevated IgG4:IgG+plasma cell ratio (14.3%). ACR/EULAR missed 50% (9/18, sensitivity-52.8%) of true IgG4-ROD cases, while OS and RCD criteria missed 11.1% (2/18, sensitivity-88.9%) of IgG-ROD cases. ACR/EULAR criteria mislabelled 7.14% (1/14, specificity-90.9%) while OS and RCD criteria wrongly categorised 71.4% (10/14, specificity-47.4%) and 50% (7/14, specificity-63.2%) specific non-IgG4-ROD cases as IgG4-ROD. Storiform fibrosis, obliterative phlebitis, increased IgG4:IgG+plasma cell ratio and elevated serum IgG were statistically significant in distinguishing IgG4-ROD from its mimics.

CONCLUSION: ACR/EULAR criteria showed high specificity but were cumbersome and sensitivity was low, while RCD and OS criteria showed low specificity. Stringent clinicopathological correlation to exclude mimics is critical in avoiding diagnostic errors in IgG4-ROD.

PMID:39160060 | DOI:10.1136/jcp-2024-209552

Food Res Int. 2024 Oct;193:114865. doi: 10.1016/j.foodres.2024.114865. Epub 2024 Aug 7.

ABSTRACT

Restoring relevant context during consumer sensory testing using virtual reality (VR) technologies may facilitate evaluations reflective of real-world experiences, enabling reliable data collection to better predict product success. Prior research has applied the same consumption scenario to all participants without accounting for variations in individual consumption habits. Thus, a consumption scenario of low personal relevance can lead to misleading conclusions. This study aimed to investigate how personal relevance (usage frequency and similarity) of a consumption environment influences consumer perception and acceptance during product evaluations. Using a VR system, 63 consumers evaluated four commercial frozen chicken nuggets in three virtual environments one week apart: sensory booth, high-relevance kitchen, and low-relevance kitchen. Participants assessed the products virtually on overall liking, Check-All-That-Apply (CATA) on 20 attributes, and purchase intent. They also completed a virtual presence and engagement questionnaire after testing. Results found better product discrimination in both kitchen environments compared to the booth as demonstrated in more post-hoc statistical subgroups (p’s < 0.05) on liking and purchase intent. Additionally, more significant product differences were found among CATA attributes in the kitchens. CATA penalty-lift analyses indicated that sensory attributes had more pronounced positive and negative impacts on liking in the high relevance kitchen, followed by the low relevance kitchen, and lastly the booth. Consumers were equally present and engaged during testing across conditions (p’s > 0.05). Results suggest providing a personally relevant consumption environment via VR technologies for consumer testing generated more discriminating data that can improve the quality of consumer insights.

PMID:39160036 | DOI:10.1016/j.foodres.2024.114865

Med Eng Phys. 2024 Aug;130:104203. doi: 10.1016/j.medengphy.2024.104203. Epub 2024 Jul 4.

ABSTRACT

Statistical shape models (SSMs) are useful tools in evaluating variation in bony anatomy to assess pathology, plan surgical interventions, and inform the design of orthopaedic implants and instrumentation. Recently, by considering multiple bones spanning a joint or the whole lower extremity, SSMs can support studies investigating articular conformity and joint mechanics. The objective of this study was to assess tradeoffs in accuracy between SSMs of the femur or tibia individually versus a combined joint-level model. Three statistical shape models were developed (femur-only, tibia-only, and joint-level) for a training set of 179 total knee arthroplasty (TKA) patients with osteoarthritis representing both genders and several ethnicities. Bone geometries were segmented from preoperative CT scans, meshed with triangular elements, and registered to a template for each SSM. Principal component analysis was performed to determine modes of variation. The statistical shape models were compared using measures of compactness, accuracy, generalization, and specificity. The generalization evaluation, assessing the ability to describe an unseen instance in a leave-one-out analysis, showed that errors were consistently smaller for the individual femur and tibia SSMs than for the joint-level model. However, when additional modes were included in the joint-level model, the errors were comparable to the individual bone results, with minimal additional computational expense. When developing more complex SSMs at the joint, lower limb, or whole-body level, the use of an error threshold to inform the number of included modes, instead of 95 % of the variation explained, can help to ensure accurate representations of anatomy.

PMID:39160028 | DOI:10.1016/j.medengphy.2024.104203

Med Eng Phys. 2024 Aug;130:104216. doi: 10.1016/j.medengphy.2024.104216. Epub 2024 Aug 3.

ABSTRACT

PURPOSE: Rehabilitation technology can be used to provide intensive training in the early phases after stroke. The current study aims to assess the feasibility of combining robotics and functional electrical stimulation (FES), with an assist-as-needed approach to support actively-initiated leg movements in (sub-)acute stroke patients.

METHOD: Nine subacute stroke patients performed repetitions of ankle dorsiflexion and/or knee extension movements, with and without assistance. The assist-as-needed algorithm determined the amount and type of support needed per repetition. The number of repetitions and range of motion with and without assistance were compared with descriptive statistics. Fatigue scores were obtained using the visual analogue scale (score 0-10).

RESULTS: Support was required in 44 % of the repetitions for ankle dorsiflexion and in 5 % of the repetitions of knee extension, The median fatigue score was 2.0 (IQR: 0.2) and 4.0 (IQR: 1.5) for knee and ankle, respectively, indicating mild to moderate perceived fatigue.

CONCLUSION: This study demonstrated the feasibility of assist-as-needed assistance through combined robotic and FES support of leg movements in stroke patients. It proved particularly useful for ankle dorsiflexion. Future research should focus on implementing this approach in a clinical setting, to assess clinical applicability and potential effects on leg function.

PMID:39160022 | DOI:10.1016/j.medengphy.2024.104216