Category: Nevin Manimala

Biostatistics. 2024 Aug 5:kxae030. doi: 10.1093/biostatistics/kxae030. Online ahead of print.

ABSTRACT

The under-5 mortality rate (U5MR), a critical health indicator, is typically estimated from household surveys in lower and middle income countries. Spatio-temporal disaggregation of household survey data can lead to highly variable estimates of U5MR, necessitating the usage of smoothing models which borrow information across space and time. The assumptions of common smoothing models may be unrealistic when certain time periods or regions are expected to have shocks in mortality relative to their neighbors, which can lead to oversmoothing of U5MR estimates. In this paper, we develop a spatial and temporal smoothing approach based on Gaussian Markov random field models which incorporate knowledge of these expected shocks in mortality. We demonstrate the potential for these models to improve upon alternatives not incorporating knowledge of expected shocks in a simulation study. We apply these models to estimate U5MR in Rwanda at the national level from 1985 to 2019, a time period which includes the Rwandan civil war and genocide.

PMID:39103178 | DOI:10.1093/biostatistics/kxae030

BMJ Ment Health. 2024 Aug 4;27(1):e300971. doi: 10.1136/bmjment-2023-300971.

ABSTRACT

QUESTION: For parents of children and young people (CYP) with diagnosed mental health difficulties, what are the levels of parents’ well-being and psychological need?

STUDY SELECTION AND ANALYSIS: Medline, PsycINFO, EMBASE, AMED, CINAHL, Web of Science and Cochrane Library of Registered Trials were searched from inception to June 2023.

INCLUSION CRITERIA: parents of CYP aged 5-18 years with formal mental health diagnosis. Data were extracted from validated measures of well-being or psychological needs with established cut-off points or from a controlled study.

FINDINGS: 32 of the 73 310 records screened were included. Pooled means showed clinical range scores for one measure of depression, and all included measures of anxiety, parenting stress and general stress. Meta-analyses showed greater depression (g=0.24, 95% CI 0.11 to 0.38) and parenting stress (g=0.34, 95% CI 0.20 to 0.49) in parents of CYP with mental health difficulties versus those without. Mothers reported greater depression (g=0.42, 95% CI 0.18 to 0.66) and anxiety (g=0.73, 95% CI 0.27 to 1.18) than fathers. Narrative synthesis found no clear patterns in relation to CYP condition. Rates of parents with clinically relevant levels of distress varied. Typically, anxiety, parenting stress and general stress scored above clinical threshold. Quality appraisal revealed few studies with a clearly defined control group, or attempts to control for important variables such as parent gender.

CONCLUSIONS: The somewhat mixed results suggest clinical anxiety, parenting and general stress may be common, with sometimes high depression. Assessment and support for parents of CYP with mental health problems is required. Further controlled studies, with consideration of pre-existing parental mental health difficulties are required.

PROSPERO REGISTRATION NUMBER: CRD42022344453.

PMID:39103177 | DOI:10.1136/bmjment-2023-300971

BMJ. 2024 Aug 5;386:q1732. doi: 10.1136/bmj.q1732.

NO ABSTRACT

PMID:39103172 | DOI:10.1136/bmj.q1732

BMJ. 2024 Aug 5;386:e073515. doi: 10.1136/bmj-2022-073515.

NO ABSTRACT

PMID:39103171 | DOI:10.1136/bmj-2022-073515

BMJ. 2024 Jul 30;386:q1694. doi: 10.1136/bmj.q1694.

NO ABSTRACT

PMID:39103166 | DOI:10.1136/bmj.q1694

J Dermatolog Treat. 2024 Dec;35(1):2386973. doi: 10.1080/09546634.2024.2386973. Epub 2024 Aug 5.

ABSTRACT

BACKGROUND: Biological therapies are effective for psoriasis, but patient responses vary, often requiring therapy switching or discontinuation.

OBJECTIVES: To identify physicians’ prescribing patterns of biological therapies at a referral tertiary center in Saudi Arabia and assess the probability of biologic persistence following treatment initiation.

METHODS: We conducted a retrospective study of biologic-naïve adult psoriasis patients who initiated therapy from October 2013 to July 2022 in Dammam. Descriptive statistics and a Kaplan-Meier analysis evaluated treatment persistence at 6, 12, 24, and 36 months.

RESULTS: A total of 151 patients received adalimumab (n = 89), etanercept (n = 17), risankizumab (n = 30), ustekinumab (n = 14), and ixekizumab (n = 1). At 6 months, all therapies demonstrated 100% persistence. At 12 months, persistence was highest for ustekinumab (100%) and lowest for etanercept (88.2%). At 24 months, ustekinumab maintained 100% persistence, followed by risankizumab (96.6%), adalimumab (94.3%), and etanercept (76.4%). At 36 months, risankizumab had the highest persistence (96.6%), followed by adalimumab (83.1%), ustekinumab (78%), and etanercept (70.6%). The most common reasons for discontinuation were lack of effectiveness and intolerability.

CONCLUSION: This study shows changing psoriasis treatment patterns with new therapies. Risankizumab demonstrated high long-term persistence, while etanercept and ustekinumab showed declining persistence, suggesting evolving treatment considerations.

PMID:39103160 | DOI:10.1080/09546634.2024.2386973

J Oral Maxillofac Surg. 2024 Jul 20:S0278-2391(24)00652-9. doi: 10.1016/j.joms.2024.07.011. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative pain after orthognathic surgery is commonly managed with opioids, which can cause nausea and vomiting.

PURPOSE: The purpose of this study was to determine whether regional nerve blocks during bimaxillary surgery reduced postoperative pain and vomiting compared with patient-controlled analgesia (PCA).

STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study recruited patients who underwent bimaxillary surgery between August 2018 and September 2020 at the Fourth Military Medical University Hospital. Participants whose procedures involved the cheekbone, temporomandibular joint, mandibular angle, or an autogenous iliac bone graft and those who were admitted to the intensive care unit after surgery were excluded.

PREDICTOR VARIABLES: The primary predictor variables were postoperative analgesia management, regional maxillary and inferior alveolar nerve blocks, and PCA.

OUTCOME VARIABLES: The primary outcome variables were moderate-to-severe postoperative pain and postoperative vomiting (POV) during the first 24 hours. Moderate-to-severe pain was defined as pain numerical rating scale ≥4, POV was defined as vomiting of gastrointestinal contents.

COVARIATES: The study covariates included demographic, surgical, and anesthesia characteristics.

ANALYSES: Statistical analyses were conducted using an unpaired t-test, χ² test, or Fisher’s exact test for the bivariate analysis. A multivariate logistic regression analysis was performed to assess the associations between the primary predictor variables and outcomes. Statistical significance was set at P < .05.

RESULTS: 354 participants were included in the study (262 in the nerve block group, mean age 22.5 ± 4.0 years; 92 in the PCA group, mean age 22.6 ± 4.4 years; P = .81). There was no significant difference in sex between the groups (63.4 and 55.4% females in nerve block and PCA groups, respectively, P = .18). The multivariate regression analyses demonstrated that nerve blocks did not decrease moderate-to-severe postoperative pain (7.6 vs 10.9%, adjusted odds ratio = 0.67, 95% confidence interval: 0.22-2.01, P = .48), although they were associated with decreased POV (38.5 vs 65.2%, adjusted odds ratio = 0.34, 95% confidence interval: 0.18-0.65, P = .001).

CONCLUSION AND RELEVANCE: For bimaxillary surgery, regional nerve blocks as opioid-free postoperative analgesia were not significantly associated with decreased postoperative pain but were associated with a low POV risk.

PMID:39103152 | DOI:10.1016/j.joms.2024.07.011

J Oral Maxillofac Surg. 2024 Jul 20:S0278-2391(24)00651-7. doi: 10.1016/j.joms.2024.07.010. Online ahead of print.

ABSTRACT

BACKGROUND: Retrusive profiles show an appearance of aging with an under-projected vermilion and pronounced nasolabial folds due to deficient bone support.

PURPOSE: A study was made of the association between orthognathic surgery and changes in the nasolabial and vermilion areas in patients with retrusive profiles.

STUDY DESIGN, SETTING, SAMPLE: A retrospective cohort study evaluated patients subjected to bimaxillary surgery according to the Barcelona Line (BL) protocol during 2021 at Teknon Medical Center (Barcelona, Spain). Subjects with craniofacial syndromes, facial esthetic procedures, and dental rehabilitations involving lip changes, were excluded.

PREDICTOR VARIABLE: The predictor variable was the timing of cephalometric measures, reported as T0 (preoperatively), T1 (1 month after surgery), and T2 (after 1 year of follow-up).

MAIN OUTCOME VARIABLE: The outcome variable corresponded to the soft tissue changes of the nasolabial and vermilion area, reported as the nasolabial fold length and angle, nasolabial angle, upper lip concavity, vermilion length, and upper lip sagittal distance from BL.

COVARIATES: The covariates comprised patient demographic data, the surgical-orthodontic protocol, and the magnitude and direction of the skeletal movements.

ANALYSES: Descriptive and inferential analyses were performed based on analysis of variance, the Bonferroni test, Pearson’s linear coefficient, the nonparametric Mann-Whitney U-test, Kruskal-Wallis test, and multiple linear regression models. Statistical significance was considered for P < .05.

RESULTS: The sample comprised 27 subjects with a mean age of 32.5 ± 11.2 years. A mean decrease in nasolabial angle of 5.5 ± 6° was recorded (P < .001), with a shortening of the nasolabial fold length of 4.4 ± 7.6 mm (P = .019). An increase in upper lip concavity angle of 14.4 ± 12° was recorded (P < .001), along with a vermilion lengthening of 1.6 ± 1.3 mm (P < .001) and an increase in upper lip sagittal distance to BL of 5.7 ± 7.3 mm (P = .001), indicating a more projected and everted upper vermilion.

CONCLUSIONS AND RELEVANCE: When adequate dentoskeletal support is provided by specific positional changes of the jaws planned through orthognathic surgery, the length of the nasolabial fold decreases, and the upper vermilion lengthens and becomes slightly everted.

PMID:39103151 | DOI:10.1016/j.joms.2024.07.010

J Am Med Dir Assoc. 2024 Aug 2:105179. doi: 10.1016/j.jamda.2024.105179. Online ahead of print.

ABSTRACT

OBJECTIVES: Telemedicine has become a widely accepted alternative to face-to-face patient encounters. Although there have been several peer-reviewed journal articles on incorporating telemedicine into the medical school curriculum, particularly during the COVID-19 pandemic, assessments of the effectiveness of remote supervision of medical students have not been reported. This prospective cohort study of student subjects using observational survey data evaluated the efficacy of telemedicine as an educational resource by comparing learning outcomes between osteopathic medical students receiving direct (physically present) supervision with a group who received remote (telemedicine) supervision by clinical faculty within a post-acute/long-term care (PA/LTC) setting. Learning outcomes in the domains of patient rapport, attitudes, knowledge, and behavior were measured using standardized survey instruments.

DESIGN: Prospective cohort study of student subjects using observational survey data.

SETTING AND PARTICIPANTS: A total of 167 fourth-year osteopathic medical students at a teaching nursing home (TNH).

METHODS: A total of 167 fourth-year osteopathic medical students (OMS-4s) were randomly assigned face-to-face PA/LTC patient encounters at the TNH. The encounters were follow-up visits to residents of the TNH that were supervised by faculty geriatricians. Half were accompanied by the physician and the other half were supervised by the physician through telemedicine. Evaluation using validated survey instruments measured patient rapport, verbal communication, and physical examination skills as well as attitudes, knowledge, and behaviors of the student/subjects.

RESULTS: A nonparametric statistical analysis of 4 dependent variables measuring patient rapport, attitudes, knowledge and behavior showed no significant difference between the 2 teaching modalities.

CONCLUSIONS AND IMPLICATIONS: The results of this prospective cohort study indicate that telemedicine supervision is comparable (noninferior) to direct supervision of medical student trainees in a PA/LTC setting.

PMID:39103150 | DOI:10.1016/j.jamda.2024.105179

Orthop Traumatol Surg Res. 2024 Aug 3:103966. doi: 10.1016/j.otsr.2024.103966. Online ahead of print.

ABSTRACT

BACKGROUND: Vasospasm (VS) in microsurgery is a source of surgical complications, repeat operations, stress for the patient and the surgical team, as well as increased length of stay. Various risk factors have been identified but knowledge regarding the implicated mechanism remains limited.

HYPOTHESIS: Our objective was to determine if the harvesting conditions for microsurgical toe transfers could increase the risk of VS. Our secondary objective was to determine the correlation between VS occurrence before flap division, and the occurrence of vascular complications after completion of vascular anastomoses.

PATIENTS AND METHODS: Primary endpoints were the existence of locoregional anaesthesia of the lower limb, the Gilbert classification, the nature of the graft taken from the foot, the characteristics of the patients and smoking status. Our secondary endpoints were the presence of secondary VS or microsurgical failure. This series consists of 14 toe transfers over a 30-month period. Primary VS was defined as occurring prior to flap division, while secondary VS occurred after transfer.

RESULTS: In this series, we identified 4 cases of primary VS. The average age of the operated population was 30.6 ± 11.2 years (16-58). The patients who presented with primary VS had a mean age of 35.3 ± 16.2 years (21-58), with no statistical difference with the other group (p = 0.54). There was a statistically significant difference between the absence of locoregional anaesthesia and the occurrence of primary VS in toe transfer (p = 0.0008). Microsurgical failure occurred in 1 case. This failure was linked to the presence of a primary VS. Gilbert’s classification and type of graft were not predictive of VS (p = 0.15 and p = 0.08, respectively). The occurrence of secondary VS was statistically linked to the occurrence of primary VS (p = 0.009).

DISCUSSION: The occurrence of VS remains unpredictable and the effectiveness of available treatments is debated in the literature. Faced with the failure of curative treatments, this study aimed to determine predictive factors for VS. The existence of secondary VS, when prolonged and non-responsive to conventional measures, can lead to anastomotic revision. Performing locoregional anaesthesia on the lower limb makes it possible to effectively combat the occurrence of VS. The absence of primary VS was correlated with an absence of secondary VS and an absence of microsurgical failure. In addition to controlling vasospasm, regional anaesthesia provides effective analgesia at the harvesting site.

LEVEL OF EVIDENCE: IV.

PMID:39103146 | DOI:10.1016/j.otsr.2024.103966