Category: Nevin Manimala

Eur Heart J Digit Health. 2024 Oct 14;6(1):23-44. doi: 10.1093/ehjdh/ztae074. eCollection 2025 Jan.

ABSTRACT

AIMS: Accurate prediction of clinical outcomes following percutaneous coronary intervention (PCI) is essential for mitigating risk and peri-procedural planning. Traditional risk models have demonstrated a modest predictive value. Machine learning (ML) models offer an alternative risk stratification that may provide improved predictive accuracy.

METHODS AND RESULTS: This study was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies and Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis guidelines. PubMed, EMBASE, Web of Science, and Cochrane databases were searched until 1 November 2023 for studies comparing ML models with traditional statistical methods for event prediction after PCI. The primary outcome was comparative discrimination measured by C-statistics with 95% confidence intervals (CIs) between ML models and traditional methods in estimating the risk of all-cause mortality, major bleeding, and the composite outcome major adverse cardiovascular events (MACE). Thirty-four models were included across 13 observational studies (4 105 916 patients). For all-cause mortality, the pooled C-statistic for top-performing ML models was 0.89 (95%CI, 0.84-0.91), compared with 0.86 (95% CI, 0.80-0.93) for traditional methods (P = 0.54). For major bleeding, the pooled C-statistic for ML models was 0.80 (95% CI, 0.77-0.84), compared with 0.78 (95% CI, 0.77-0.79) for traditional methods (P = 0.02). For MACE, the C-statistic for ML models was 0.83 (95% CI, 0.75-0.91), compared with 0.71 (95% CI, 0.69-0.74) for traditional methods (P = 0.007). Out of all included models, only one model was externally validated. Calibration was inconsistently reported across all models. Prediction Model Risk of Bias Assessment Tool demonstrated a high risk of bias across all studies.

CONCLUSION: Machine learning models marginally outperformed traditional risk scores in the discrimination of MACE and major bleeding following PCI. While integration of ML algorithms into electronic healthcare systems has been hypothesized to improve peri-procedural risk stratification, immediate implementation in the clinical setting remains uncertain. Further research is required to overcome methodological and validation limitations.

PMID:39846069 | PMC:PMC11750198 | DOI:10.1093/ehjdh/ztae074

Eur Heart J Digit Health. 2024 Nov 4;6(1):126-136. doi: 10.1093/ehjdh/ztae081. eCollection 2025 Jan.

ABSTRACT

AIMS: Many studies have utilized data sources such as clinical variables, polygenic risk scores, electrocardiogram (ECG), and plasma proteins to predict the risk of atrial fibrillation (AF). However, few studies have integrated all four sources from a single study to comprehensively assess AF prediction.

METHODS AND RESULTS: We included 8374 (Visit 3, 1993-95) and 3730 (Visit 5, 2011-13) participants from the Atherosclerosis Risk in Communities Study to predict incident AF and prevalent (but covert) AF. We constructed a (i) clinical risk score using CHARGE-AF clinical variables, (ii) polygenic risk score using pre-determined weights, (iii) protein risk score using regularized logistic regression, and (iv) ECG risk score from a convolutional neural network. Risk prediction performance was measured using regularized logistic regression. After a median follow-up of 15.1 years, 1910 AF events occurred since Visit 3 and 229 participants had prevalent AF at Visit 5. The area under curve (AUC) improved from 0.660 to 0.752 (95% CI, 0.741-0.763) and from 0.737 to 0.854 (95% CI, 0.828-0.880) after addition of the polygenic risk score to the CHARGE-AF clinical variables for predicting incident and prevalent AF, respectively. Further addition of ECG and protein risk scores improved the AUC to 0.763 (95% CI, 0.753-0.772) and 0.875 (95% CI, 0.851-0.899) for predicting incident and prevalent AF, respectively.

CONCLUSION: A combination of clinical and polygenic risk scores was the most effective and parsimonious approach to predicting AF. Further addition of an ECG risk score or protein risk score provided only modest incremental improvement for predicting AF.

PMID:39846068 | PMC:PMC11750194 | DOI:10.1093/ehjdh/ztae081

Eur Heart J Digit Health. 2024 Nov 21;6(1):96-103. doi: 10.1093/ehjdh/ztae091. eCollection 2025 Jan.

ABSTRACT

AIMS: Atrial fibrillation (AF) leads to impaired exercise capacity, and catheter ablation (CA) for AF improves exercise capacity. However, the precise changes in daily activities after CA for AF remain unclear. The authors aimed to evaluate the changes in daily activities following CA for AF using a wristwatch-type pulse wave monitor (PWM), which tracks steps and exercise time, estimates burnt daily calories, and records sleep duration, in addition to establishing the rhythm diagnosis of AF or non-AF.

METHODS AND RESULTS: One hundred and twenty-three patients with AF (97 paroxysmal, 26 persistent) wore a wristwatch-type PWM for 1 week duration at three time points: before, 1 month after, and 3 months after ablation. Daily activity data were compared. Steps did not change in both groups, and the number of burnt daily calories and total exercise time increased after CA in patients with paroxysmal AF (burnt daily calories: before, 1591 kcal/day; 1 month, 1688 kcal/day; and 3 months, 1624 kcal/day; P < 0.001 and exercise time: before, 45.8 min; 1 month, 51.2 min; and 3 months, 56.3 min; P = 0.023). Sleep hours significantly increased (paroxysmal AF: before, 6.8 h; 1 month, 7.1 h; and 3 months, 7.1 h; P = 0.039 and persistent AF: before, 6.0 h; 1 month, 7.0 h; and 3 months, 7.0 h; P = 0.007).

CONCLUSION: Using a wristwatch-type PWM, we demonstrated changes in daily activities after CA in patients with AF.

TRIAL REGISTRATION NUMBER: jRCT1030210022.

PMID:39846064 | PMC:PMC11750189 | DOI:10.1093/ehjdh/ztae091

Cancer Treat Res Commun. 2025 Jan 17;42:100870. doi: 10.1016/j.ctarc.2025.100870. Online ahead of print.

ABSTRACT

AIM: Breast cancer is the second most common cancer among women and the leading cause of cancer-related mortality in this population. Numerous factors have been identified as either risk factors or protective factors for breast cancer. However, the role of Vitamin D (Vit. D) in breast cancer remains contentious, with conflicting findings in the literature. The present study aimed to compare serum Vit. D levels between women with and without breast cancer.

METHODS: This cross-sectional study included 40 women diagnosed with breast cancer, referred to the Mahdia Hamadan Radiotherapy Center in 2022. These participants were matched with 40 age- and Vit. D serum level-matched women without breast cancer. Serum Vit. D levels were measured using the ELISA method. Statistical analysis was performed using SPSS version 26, with a significance threshold set at a 95% confidence level.

RESULTS: The mean ± standard deviation of serum Vit. D levels in women with and without breast cancer were 31.9 ± 28.27 ng/mL and 37.98 ± 15.89 ng/mL, respectively (P = 0.024). The prevalence of Vit. D insufficiency was 50% in the breast cancer group and 27.5% in the control group, while 50% of the breast cancer group and 72.5% of the control group had sufficient Vit. D levels (P = 0.008). In women with breast cancer, lower Vit. D levels were significantly associated with lower educational (P < 0.001), economic (P < 0.001), and social status (P < 0.001). A weak positive correlation was observed between serum Vit. D levels and patient age (r = 0.162, P = 0.152).

CONCLUSION: The significant difference in serum Vit. D levels between women with and without breast cancer suggests that Vit. D deficiency may be associated with breast cancer risk. These findings support the hypothesis that improving Vit. D status in women could potentially reduce the incidence of breast cancer.

PMID:39842055 | DOI:10.1016/j.ctarc.2025.100870

J Surg Res. 2025 Jan 21;306:336-343. doi: 10.1016/j.jss.2024.12.036. Online ahead of print.

ABSTRACT

INTRODUCTION: Surgical site infection (SSI) after lower extremity (LE) bypass surgery is associated with longer length of stay, higher hospital cost, increased morbidity, and even graft loss. Silver impregnated dressings have been used by other surgical subspecialties to decrease SSI with reported success. The National Surgical Quality Improvement Program (NSQIP) published a national expected rate of 7.9% for SSI after open LE bypass surgery in 2018. Our institutional SSI rate in 2018 was 12.8%. In order to reduce this rate, we transitioned to silver impregnated dressings for all LE bypass procedures and studied any subsequent changes in rates of SSI.

METHODS: We used NSQIP data to retrospectively study two consecutive cohorts of vascular surgery patients at a single institution who underwent LE bypasses. Inclusion criteria were open infrainguinal LE bypass patients who were selected via Current Procedural Terminology codes. Patients in 2019 who underwent LE bypass received dry sterile dressing (DSD) postoperatively. Patients in 2020 who underwent LE bypass were treated with silver impregnated dressings postoperatively. NSQIP criteria were used to determine if patients in both cohorts developed SSIs within 30 d of surgery. Fischer’s exact and Χ2 test were used to compare groups before and after the intervention. Placement of silver dressings in the intervention cohort was confirmed using review of the medical chart and operative billing reports.

RESULTS: A total of 282 patients who underwent LE bypass in 2019 and 2020 met inclusion criteria. The standard of care cohort had 168 patients with DSD, while the cohort after intervention had 114 patients with silver impregnated dressings. The groups were similar in terms of demographics and comorbidities (Table 1). There was a statistically significant reduction in superficial SSI in the silver dressing group compared to the DSD group (9.6% versus 20.8%, P = 0.014, Table 2). There was a 63% compliance with silver dressing placement in the intervention group. This subset of patients with confirmed dressing placement was similar in terms of demographics and comorbidities (Table 3). Superficial SSI in this patient cohort was decreased from 20.8 to 12.5% (P = 0.15, Table 4). There was no observed difference in deep or organ space infections, wound dehiscence, readmission, and return to operating room between both groups.

CONCLUSIONS: This study demonstrated a statistically significant reduction in the rate of superficial SSI in patients undergoing open LE bypass with the use of a silver impregnated dressing when compared to a sterile gauze dressing. Although our study does not demonstrate a causal relationship, this relatively inexpensive and low-risk intervention’s association with a significant decrease in an otherwise very serious postoperative complication argues for a change in clinical practice or prospective confirmatory studies to optimize patient outcomes after LE bypass.

PMID:39842047 | DOI:10.1016/j.jss.2024.12.036

J Surg Res. 2025 Jan 21;306:327-335. doi: 10.1016/j.jss.2024.12.004. Online ahead of print.

ABSTRACT

INTRODUCTION: Assessing gender disparity in surgical trainees’ operative opportunities and experience quantifies implicit gender bias and reflects a summation of many smaller biased interactions within the operating room environment. Highlighting gender disparity in surgery informs a platform for advocacy.

METHODS: A systematic literature search was performed using Medline, Web of Science, OpenMD and Science Direct consistent with the Preferred Reporting Items for Systematic Reviews and Metanalysis guidelines. A Boolean search strategy was used to identify articles relevant to gender in operative surgery. Only English language studies that assessed the gender of surgical trainees with regards to operative cases for total and/or autonomously performed case numbers were included.

RESULTS: Fifteen papers assessing the influence of gender on operative opportunities for trainee surgeons were identified. A discrepancy between the operative experiences of men and women trainee surgeons was found. Of eight studies assessing gender differences in total case numbers, four reported women undertaking fewer total cases than men; a similar trend was demonstrated in two studies that failed to reach statistical significance. Eight of eleven studies examining surgical autonomy reported more surgical autonomy afforded to men trainee surgeons than women.

CONCLUSIONS: A gendered bias in the operative opportunities afforded to trainee surgeons is suggested in the literature, reflecting implicit bias that underlies surgical culture worldwide. Although surgical specialties continue to have vast gender inequity, we fail to leverage talent and the benefits of diverse skills and experience, to the detriment of ourselves and our patients. Quantifying this issue will inform change.

PMID:39842046 | DOI:10.1016/j.jss.2024.12.004

Cancer Nurs. 2025 Jan 21. doi: 10.1097/NCC.0000000000001443. Online ahead of print.

ABSTRACT

BACKGROUND: Colorectal cancer is a major cause of cancer-related deaths in China. Timely screening is essential for reducing mortality, but implementing comprehensive programs in Chinese healthcare settings is challenging.

OBJECTIVE: This study identifies barriers and facilitators to colorectal cancer screening (CRCS) in China and recommends effective implementation strategies.

METHODS: Conducted from October 2023 to April 2024, this mixed-methods study under the Consolidated Framework for Implementation Research involved 128 practitioners and 440 residents near 5 community health centers and 4 tertiary care hospitals in Harbin, Heilongjiang Province. Quantitative data were analyzed using descriptive statistics and logistic regression, whereas qualitative data from 21 practitioners and 23 community members underwent directed content analysis.

RESULTS: The study identified 18 facilitators and 29 barriers to CRCS implementation in China, analyzed across 5 Consolidated Framework for Implementation Research domains: innovation (2 facilitators, 5 barriers), outer setting (5 facilitators, 4 barriers), inner setting (3 facilitators, 4 barriers), individual characteristics (5 facilitators, 11 barriers), and implementation process (3 facilitators, 5 barriers).

CONCLUSION: This study highlights critical facilitators and barriers from the perspectives of healthcare professionals and the screening-eligible population. It suggests strategies to enhance early CRCS initiatives in China, including regular training, public education, financial support, and improved accessibility.

IMPLICATIONS FOR PRACTICE: The findings from this study provide actionable insights for enhancing the implementation of CRCS in Chinese healthcare settings.

PMID:39842030 | DOI:10.1097/NCC.0000000000001443

Clin Orthop Relat Res. 2025 Jan 21. doi: 10.1097/CORR.0000000000003356. Online ahead of print.

ABSTRACT

BACKGROUND: There is debate as to whether kinematic TKA or mechanical alignment TKA is superior. Recent systematic reviews have suggested that kinematically aligned TKAs may be the preferred option. However, the observed differences in alignment favoring kinematic alignment may not improve outcomes (performance or durability) in ways that patients can perceive, and likewise, statistical differences in outcome scores sometimes observed in clinical trials may be too small for patients to notice. Minimum clinically important differences (MCIDs) are changes that are deemed meaningful to the patient. A meta-analysis of randomized trials that frames results on this topic in terms of MCIDs may therefore be informative to surgeons and their patients.

QUESTIONS/PURPOSES: (1) Does kinematic alignment for TKA insertion improve patient-reported outcome measures (PROMs) by clinically important margins (for example, 5 points of 48 on the adjusted Oxford Knee Score [OKS] or 13.7 points of 100 on the Forgotten Joint Score [FJS]) compared with mechanical alignment? (2) Does kinematic alignment for TKA insertion improve ROM by a clinically important margin (defined as 3.8° to 6.4° in flexion) compared with mechanical alignment?

METHODS: A systematic review of Medline and Embase databases was performed from inception to January 29, 2023, the date of search. We identified RCTs comparing mechanical alignment TKA with kinematic alignment TKA. All English-language RCTs comparing PROMs data in kinematic versus mechanical alignment TKAs performed in patients 18 years or older were included. Studies that were not in English, involved overlapping reports of the same trial, and/or utilized nonrandomized controlled trial methodology were excluded. Conference abstracts or study protocols, pilot studies, and review articles were also excluded. Two reviewers screened abstracts, full-text, and extracted data and assessed included studies for risk of bias using the Cochrane Risk of Bias tool, version 2. Twelve randomized controlled trials (RCTs) were identified, which included 1033 patients with a mean age of 68 years (range 40 to 94) from eight countries who were undergoing primary TKA. Six studies were determined to be low risk of bias, with the remaining six studies were determined to be of moderate-to-high risk of bias. As a result, we would expect that the included studies might overestimate the benefit of the newer approach. Outcomes included ROM and PROMs. Where feasible, pooled analysis was completed. PROMs data were extracted from nine pooled studies, with a randomized n = 443 in the kinematic alignment group and n = 435 in the mechanical alignment group. ROM data were extracted from six pooled studies, with randomized n = 248 in the kinematic alignment group and n = 243 in the mechanical alignment group. PROMS were converted to common scales where possible. Multiple versions of the OKS exist; therefore, OKS scores were converted if needed to a 0 to 48 Oxford scale, in which higher scores represent better clinical outcomes. WOMAC scores were converted to OKS using previously reported techniques. The OKS and converted WOMAC scores were represented as “functional scores” in our data set because of their conversion. An MCID of 5 was utilized as previously documented for the OKS. Heterogeneity was assessed using the I2 statistic, and for an I2 of > 25%, random-effects models were utilized.

RESULTS: In nine pooled studies, we found no clinically important difference between the kinematic and mechanical alignment groups in terms of our generated functional score (mean difference 3 of possible 48 [95% confidence interval (CI) 0.81 to 4.54]; p = 0.005). The functional score included OKS and WOMAC scores converted to OKS. The difference did not exceed the MCID for the OKS. In three pooled studies, we found no difference between the kinematic and mechanical alignment groups in terms of FJS at 1 to 2 years (mean difference 4 of possible 200 [95% CI -1.77 to 9.08]; p = 0.19). In three pooled studies, we found no difference between the kinematic and mechanical alignment groups in terms of EuroQol 5-domain instrument VAS score at 1 to 2 years (mean difference 0.2 of possible 100 [95% CI -3.17 to 3.61]; p = 0.90). We found no clinically meaningful difference between kinematic TKA and mechanical alignment TKA for ROM (extension mean difference 0.1° [95% CI -1.08 to 1.34]; p = 0.83, and flexion mean difference 3° [95% CI 0.5 to 5.61]; p = 0.02).

CONCLUSION: This meta-analysis found no clinically important benefit favoring kinematic over mechanical alignment in TKA based on the available RCTs. Because patients cannot perceive advantages to kinematic alignment, and because it adds costs, time (if using advanced technologies), and potential risks to the patient that are associated with novelty, it should not be widely adopted in practice until or unless such advantages have been shown in well-designed RCTs.

LEVEL OF EVIDENCE: Level I, therapeutic study.

PMID:39842026 | DOI:10.1097/CORR.0000000000003356

JMIR Hum Factors. 2025 Jan 22;12:e56521. doi: 10.2196/56521.

ABSTRACT

BACKGROUND: Patients with cerebrovascular accident (CVA) should be involved in setting their rehabilitation goals. A personalized prediction of CVA outcomes would allow care professionals to better inform patients and informal caregivers. Several accurate prediction models have been created, but acceptance and proper implementation of the models are prerequisites for model adoption.

OBJECTIVE: This study aimed to assess the added value of a prediction model for long-term outcomes of rehabilitation after CVA and evaluate how it can best be displayed, implemented, and integrated into the care process.

METHODS: We designed a mock-up version, including visualizations, based on our recently developed prediction model. We conducted focus groups with CVA patients and informal caregivers, and separate focus groups with health care professionals (HCPs). Their opinions on the current information management and the model were analyzed using a thematic analysis approach. Lastly, a Measurement Instrument for Determinants of Innovations (MIDI) questionnaire was used to collect insights into the prediction model and visualizations with HCPs.

RESULTS: The analysis of 6 focus groups, with 9 patients, 4 informal caregivers, and 8 HCPs, resulted in 10 themes in 3 categories: evaluation of the current care process (information absorption, expectations of rehabilitation, prediction of outcomes, and decision aid), content of the prediction model (reliability, relevance, and influence on the care process), and accessibility of the model (ease of understanding, model type preference, and moment of use). We extracted recommendations for the prediction model and visualizations. The results of the questionnaire survey (9 responses, 56% response rate) underscored the themes of the focus groups.

CONCLUSIONS: There is a need for the use of a prediction model to assess CVA outcomes, as indicated by the general approval of participants in both the focus groups and the questionnaire survey. We recommend that the prediction model be geared toward HCPs, as they can provide the context necessary for patients and informal caregivers. Good reliability and relevance of the prediction model will be essential for its wide adoption.

PMID:39842003 | DOI:10.2196/56521

JMIR Res Protoc. 2025 Jan 22;14:e63583. doi: 10.2196/63583.

ABSTRACT

BACKGROUND: In South Africa, there is no centralized HIV surveillance system where key populations (KPs) data, including gay men and other men who have sex with men, female sex workers, transgender persons, people who use drugs, and incarcerated persons, are stored in South Africa despite being on higher risk of HIV acquisition and transmission than the general population. Data on KPs are being collected on a smaller scale by numerous stakeholders and managed in silos. There exists an opportunity to harness a variety of data, such as empirical, contextual, observational, and programmatic data, for evaluating the potential impact of HIV responses among KPs in South Africa.

OBJECTIVE: This study aimed to leverage and harness big heterogeneous data on HIV among KPs and harmonize and analyze it to inform a targeted HIV response for greater impact in Sub-Saharan Africa.

METHODS: The Boloka data repository initiative has 5 stages. There will be engagement of a wide range of stakeholders to facilitate the acquisition of data (stage 1). Through these engagements, different data types will be collated (stage 2). The data will be filtered and screened to enable high-quality analyses (stage 3). The collated data will be stored in the Boloka data repository (stage 4). The Boloka data repository will be made accessible to stakeholders and authorized users (stage 5).

RESULTS: The protocol was funded by the South African Medical Research Council following external peer reviews (December 2022). The study received initial ethics approval (May 2022), renewal (June 2023), and amendment (July 2024) from the University of Johannesburg (UJ) Research Ethics Committee. The research team has been recruited, onboarded, and received non-web-based internet ethics training (January 2023). A list of current and potential data partners has been compiled (January 2023 to date). Data sharing or user agreements have been signed with several data partners (August 2023 to date). Survey and routine data have been and are being secured (January 5, 2023). In (September 2024) we received Ghana Men Study data. The data transfer agreement between the Pan African Centre for Epidemics Research and the Perinatal HIV Research Unit was finalized (October 2024), and we are anticipating receiving data by (December 2024). In total, 7 abstracts are underway, with 1 abstract completed the analysis and expected to submit the full article to the peer-reviewed journal in early January 2024. As of March 2025, we expect to submit the remaining 6 full articles.

CONCLUSIONS: A truly “complete” data infrastructure that systematically and rigorously integrates diverse data for KPs will not only improve our understanding of local epidemics but will also improve HIV interventions and policies. Furthermore, it will inform future research directions and become an incredible institutional mechanism for epidemiological and public health training in South Africa and Sub-Saharan Africa.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63583.

PMID:39841994 | DOI:10.2196/63583