Category: Nevin Manimala

Invest Radiol. 2024 Oct 9. doi: 10.1097/RLI.0000000000001123. Online ahead of print.

ABSTRACT

OBJECTIVE: This systematic review and meta-analysis investigated the added value of DWI compared with the structured assessment of BI-RADS criteria using the Kaiser score.

MATERIALS AND METHODS: Articles published in English until May 2024 were included. Two independent reviewers extracted data on the characteristics of studies evaluating the added value of DWI to distinguish benign from malignant breast lesions compared with structured assessment of the BI-RADS criteria. Using bivariate random-effects models, the sensitivity and specificity were calculated. I2 statistics, Deek’s funnel plot asymmetry test for publication bias, and meta-regression were applied for the data analysis.

RESULTS: Five studies comprising 1005 malignant and 846 benign lesions were eligible for data synthesis. The pooled sensitivity and specificity estimates of structured BI-RADS assessment were 95.7% (95% confidence interval [CI], 92.6%-97.5%) and 68.7% (95% CI, 60.9%-75.6%), respectively. Adding DWI to the structured BI-RADS assessment achieved a pooled sensitivity of 94.4% (95% CI, 90.5%-96.7%) and a pooled specificity of 74.9% (95% CI, 68.8%-80.2%). Adding DWI to the structured BI-RADS assessment significantly changed neither the sensitivity (P = 0.52) nor the specificity (P = 0.20).

CONCLUSIONS: This systematic review and meta-analysis revealed only a limited, statistically nonsignificant added value of DWI compared with the structured assessment of BI-RADS criteria using the Kaiser score.

PMID:39724588 | DOI:10.1097/RLI.0000000000001123

Eur J Cancer Prev. 2024 Oct 1. doi: 10.1097/CEJ.0000000000000925. Online ahead of print.

ABSTRACT

Triple-negative breast cancer (TNBC) is a complex and diverse group of malignancies. Invasive ductal carcinoma (IDC) is the predominant pathological subtype and is closely linked to the ominous potential for distant metastasis, a pivotal factor that significantly influences patient outcomes. In light of these considerations, the present study was conceived with the objective of developing a nomogram model. This model was designed to predict the prognosis observed in IDC with distant metastasis in TNBC. This was a retrospective study based on the SEER database. Data of 9739 IDC-TNBC patients diagnosed from 2010 to 2020 were included in our study. Independent risk factors were screened by univariate and multivariate Cox regression analyses successively, which were used to develop a nomogram model predicting for prognosis. Cox multivariable analysis showed statistical significance in bone metastasis, liver metastasis, surgery, and chemotherapy. Incorporating statistically significant variables, as well as clinically significant age, lung metastasis, and brain metastasis into the construction of the prediction model, the C-indexes of the training group and validation group were 0.702 (0.663-0.741) and 0.667 (0.600-0.734), respectively, while the calibration curves were all close to the ideal 45° reference line, and decision curve analysis curves show excellent net benefit in the predictive model. The prognostic prediction model developed in this study demonstrated enhanced predictive accuracy, enabling a more precise evaluation of mortality risks associated with IDC with distant metastasis in TNBC.

PMID:39724567 | DOI:10.1097/CEJ.0000000000000925

Adv Neonatal Care. 2024 Dec 26. doi: 10.1097/ANC.0000000000001220. Online ahead of print.

ABSTRACT

BACKGROUND: Neonatal advanced practice providers (APPs) often work prolonged hours in high-acuity neonatal intensive care units (NICUs). It is imperative to understand how fatigue affects the APP’s ability to react quickly following long shifts. There is a lack of data on the effects of shift length and fatigue on neonatal APP job performance and clinical decision-making.

PURPOSE: The purpose of this study was to describe the variation in shift length, knowledge-based competency, personal well-being, and behavioral alertness for neonatal APPs.

METHODS: This study evaluated neonatal APPs before and after a clinical shift. Provider well-being was assessed during the pre-survey. Pretest-posttest surveys evaluated neonatal APP’s psychomotor vigilance skills and knowledge. Participants completed an online, anonymous questionnaire to answer a series of knowledge-based questions before and after their shift, along with a psychomotor vigilance test (PVT). A paired t test analysis evaluated the pre- and post-shift PVT values and knowledge-based test scores.

RESULTS: Overall, 61 pre-surveys and 42 post-surveys were completed; 36 were matched by participants pre- to post-survey. The mean between pre- and post-knowledge-based questions was statistically significant, with higher posttest scores. There was no statistical difference noted in the paired t test analysis of the PVT values.

IMPLICATIONS FOR PRACTICE AND RESEARCH: The small sample size may limit the generalizability of findings, but these results may indicate that shift length does not affect psychomotor vigilance or knowledge-based competency. It is vital that future work assess the associations between APP shift length, fatigue, and critical decision-making.

PMID:39724563 | DOI:10.1097/ANC.0000000000001220

Alcohol Alcohol. 2024 Nov 18;60(1):agae088. doi: 10.1093/alcalc/agae088.

ABSTRACT

AIMS: Structured clinical interviewing is considered the gold standard in psychiatric diagnosis. The Diagnostic Assessment Research Tool (DART) is a novel modularized, non-copywritten, semi-structured interview; however, no studies have examined the psychometric properties of its alcohol use disorder (AUD) module. The primary aims of this study were to: (i) validate the factor structure of the DART AUD module and (ii) examine measurement invariance across several key demographic and subgroup factors.

METHODS: Participants were community members in Hamilton, Canada and Boston, USA who self-identified as making a significant AUD recovery attempt (N = 499). Internal reliability was examined via the Kuder-Richardson 20 statistic, and correlations between symptom count and drinking quantity/frequency were examined. Then, symptom-level data were included in a confirmatory factor analysis to examine model fit of a single hypothesized factor structure. Finally, measurement invariance analyses were conducted for sex, age, ethnicity (White vs. racialized), and study site.

RESULTS: This study found evidence for adequate internal reliability (rKR20 = 0.75), and symptom scores correlated with drinking quantity and frequency (r = 0.16-0.43). Confirmatory factor analysis results suggested excellent fit for the unidimensional one-factor AUD model (χ2 = 0.09, confirmatory factor index = 0.99, Tucker Lewis index = 0.99, standardized root mean square residual = 0.06, root mean square error of approximation = 0.02). Measurement invariance analyses revealed that the factor structure was equivalent between sex, age, ethnicity, and study site.

CONCLUSIONS: Findings provide strong evidence for the psychometric validity of the DART AUD module and support its use in research and clinical practice. The DART represents a credible alternative to other diagnostic interviewing tools for AUD.

PMID:39724543 | DOI:10.1093/alcalc/agae088

J Am Acad Orthop Surg. 2024 Dec 24. doi: 10.5435/JAAOS-D-24-00353. Online ahead of print.

ABSTRACT

INTRODUCTION: Gender-affirming hormone therapy (GAHT) is a cornerstone of gender-affirming care for transgender and gender diverse (TGD) patients, with a direct biological role on bone metabolism. However, a paucity of data describes how GAHT influences fracture rate over time. The study’s primary objective was to describe the 5-year all-cause fracture incidence rate (IR) among TGD patients initiating estrogen-based GAHT (E-GAHT) or testosterone-based GAHT (T-GAHT), compared with TGD patients not using GAHT (non-GAHT).

METHODS: This retrospective cohort study of TGD adults aged 18 to 65 years used insurance data from the Merative MarketScan Commercial Database (MarketScan) from January 1, 2009, to December 31, 2019. The main outcome was IR (IR with 95% confidence intervals [CIs]) of all-cause fracture after up to 5 years of follow-up. The IR ratio was estimated by comparing E-GAHT and T-GAHT groups with the non-GAHT group. Cox proportional hazards regression models estimated the hazard ratio (HR) of fracture after adjusting for age, comorbidity status using Charlson Comorbidity Index (CCI), recent fractures, and study start year.

RESULTS: Nine thousand six hundred ninety-six TGD adults (E-GAHT [n = 1,131]; T-GAHT [n = 1,046]; non-GAHT [n = 7,519]) were identified using clinical and enrollment criteria. No differences in age (mean age [SD], 33.4 [13.2] years, 30.8 [11.7] years, and 33.2 [13.6] years, respectively) and CCI (percent with CCI = 0 [%CCI = 3+]; 86.7% [2.2%], 84.9% [1.4%], and 85.3% [1.9%]) were observed by group. The fracture IR was 13.9 (95% CI, 9.1 to 18.8) for E-GAHT, 15.3 (95% CI, 10.1 to 20.4) for T-GAHT, and 19.2 (95% CI, 16.9 to 21.4) for non-GAHT. Compared with non-GAHT, the crude IR ratio and fully adjusted HR was 0.73 (95% CI, 0.51 to 1.04) and 0.71 (95% CI, 0.49 to 1.02), respectively, for E-GAHT and 0.80 (95% CI, 0.56 to 1.14) and 0.78 (95% CI, 0.55 to 1.12), respectively, for T-GAHT.

CONCLUSION: Based on United States commercial claims data, the use of GAHT was not associated with 5-year all-cause fracture IR.

LEVEL OF EVIDENCE: III.

PMID:39724520 | DOI:10.5435/JAAOS-D-24-00353

Clin Neuropsychol. 2024 Dec 26:1-15. doi: 10.1080/13854046.2024.2445269. Online ahead of print.

ABSTRACT

Objective: To determine the clinical utility of teleneuropsychology (teleNP) services in screening for cognitive concerns in a population of children and adolescents presenting with long COVID. Method: This cross-sectional study evaluated 76 pediatric patients (64% female, M_age = 13.48, SD = 2.97, range = 5 to 18 years) with long COVID referred for a neuropsychological evaluation due to persistent cognitive symptoms following their COVID infection. Of these 76 patients, 33 were tested in person, while 43 were tested via teleNP at home. Patients were administered a brief testing battery designed for use in-person or through teleNP services. Tests administered included the WASI-II (Intellectual Functioning), D-KEFS Verbal Fluency (Executive Functioning/Shifting), Oral Version of the Symbol Digit Modalities Test (Processing Speed), ChAMP List (Learning and Memory), WAIS-IV/WISC-V Digit Span (Working Memory), and TEA-Ch Score and Score DT (Sustained Auditory Attention and Divided Attention). Differences in scores between those evaluated in-person or teleNP were computed using analyses of variance and Bayesian statistics across measures. Differences in the proportion of those scoring in the below average range (< 9^th percentile) were also computed. Results: Findings revealed similar performance for patients tested in-person and patients tested by teleNP modality across measures. Conclusions: The present study provides preliminary evidence for the clinical utility of teleNP services in pediatric long COVID patients on a cognitive screening battery. These results lend support for expanding teleNP services to pediatric patients with long COVID to assess neurocognitive functioning, which is particularly important given scarcity of specialty long COVID clinics.

PMID:39723582 | DOI:10.1080/13854046.2024.2445269

J Psychosoc Oncol. 2024 Dec 26:1-15. doi: 10.1080/07347332.2024.2444276. Online ahead of print.

ABSTRACT

PURPOSE: Young adults report challenges concerning cancer–related cognitive impairment (CRCI). This study aimed to: (1) describe cognition in young adults post-cancer treatment using self-report and performance-based measures, and (2) examine associations between cognition and relevant disease-related, psychological, and lifestyle (physical activity; PA) factors.

METHODS: Forty-six young adults (M_age = 31.4 ± 5.4 years; 91.3% female) completed web-based questionnaires and neuropsychological tests; data were analyzed via descriptive statistics and bivariate correlations.

RESULTS: Most (60.9%) self-reported clinically meaningful CRCI and displayed poorer executive functioning and processing speed (but not working memory) than normative data. Disease-related factors, psychological factors, and PA had null-to-moderate (rs = -0.32-0.28), small-to-large (rs = -0.74-0.77), and trivial-to-moderate (rs = -0.16 – 0.36) correlations with cognition (respectively), with differences in magnitude between self–reported and objective cognition.

CONCLUSION: The observed correlations warrant further exploration in larger prospective studies, and trials should investigate causative mechanisms and specific PA parameters.

PMID:39723581 | DOI:10.1080/07347332.2024.2444276

Biometrics. 2024 Oct 3;80(4):ujae150. doi: 10.1093/biomtc/ujae150.

ABSTRACT

In many clinical contexts, the event of interest could occur multiple times for the same patient. Considerable advancement has been made on developing recurrent event models based on or that use biomarker information. However, less attention has been given to evaluating the prognostic accuracy of a biomarker or a composite score obtained from a fitted recurrent event-rate model. In this manuscript, we propose novel measures to characterize the prognostic accuracy of a marker measured at baseline in the presence of recurrent events. The proposed estimators are based on a semiparametric frailty model that accounts for the informativeness of a marker and unobserved heterogeneity among patients with respect to the rate of event occurrence. We investigate the asymptotic properties of the proposed accuracy estimators and demonstrate these estimators’ finite sample performance through simulation studies. The proposed estimators have minimal bias and appropriate coverage. The estimators are applied to evaluate the performance of a baseline forced expiratory volume, a measure of lung capacity, for repeated episodes of pulmonary exacerbations in patients with cystic fibrosis.

PMID:39723565 | DOI:10.1093/biomtc/ujae150

Biometrics. 2024 Oct 3;80(4):ujae154. doi: 10.1093/biomtc/ujae154.

ABSTRACT

Many trials are designed to collect outcomes at or around pre-specified times after randomization. If there is variability in the times when participants are actually assessed, this can pose a challenge to learning the effect of treatment, since not all participants have outcome assessments at the times of interest. Furthermore, observed outcome values may not be representative of all participants’ outcomes at a given time. Methods have been developed that account for some types of such irregular and informative assessment times; however, since these methods rely on untestable assumptions, sensitivity analyses are needed. We develop a sensitivity analysis methodology that is benchmarked at the explainable assessment (EA) assumption, under which assessment and outcomes at each time are related only through data collected prior to that time. Our method uses an exponential tilting assumption, governed by a sensitivity analysis parameter, that posits deviations from the EA assumption. Our inferential strategy is based on a new influence function-based, augmented inverse intensity-weighted estimator. Our approach allows for flexible semiparametric modeling of the observed data, which is separated from specification of the sensitivity parameter. We apply our method to a randomized trial of low-income individuals with uncontrolled asthma, and we illustrate implementation of our estimation procedure in detail.

PMID:39723564 | DOI:10.1093/biomtc/ujae154

ANZ J Surg. 2024 Dec 26. doi: 10.1111/ans.19372. Online ahead of print.

ABSTRACT

BACKGROUND: Over the last decade, there has been a steady increase in the number of patients diagnosed with end stage renal failure (ESRF). Renal transplant remains the best available treatment for ESRF. The aim of this study is to assess the surgical outcomes following renal transplantation in a single tertiary centre in Aotearoa New Zealand.

METHODS: A retrospective observational study was performed in Christchurch Hospital. All live-related and deceased donor adult renal transplants performed between 1 January 2009 and 1 January 2023 were included in the study. Patients were identified from the local transplant database (Proton) and data were extracted from both electronic and hardcopy records.

RESULT: There were 227 live-related and 150 deceased donor renal transplants performed over the study period. Median BMI in the study cohort was 27 kg/m². The most common aetiology of ESRF was glomerular disease. Obese (BMI 30-40 kg/m²) patients had a higher incidence of post-operative complications. Ethnicity was shown to be associated with a higher incidence of post-operative complications. This was only statistically significant in the Pacific Islander group (P = 0.013). Live-related donor graft survival was 97% at 1 year and 93% at 5 years while deceased donor graft survival was 95% at 1 year and 92% at 5 years.

CONCLUSION: This study showed that graft outcome in our cohort was comparable to international data. However, further studies are needed to assess whether specific ethnic groups are truly linked to a higher incidence of post-operative complications.

PMID:39723559 | DOI:10.1111/ans.19372