Category: Nevin Manimala

J Med Internet Res. 2023 Oct 4;25:e48750. doi: 10.2196/48750.

ABSTRACT

BACKGROUND: Depression and anxiety are common comorbidities in cardiovascular clinic outpatients. Timely identification and intervention of these mental and psychological disorders can contribute to correct diagnosis, better prognosis, less medical expenses, and improved quality of life. The convenience of online doctor-patient communication platforms has increasingly attracted patients to online consultations. However, online health care and offline health care are very different. Research on how to identify psychological disorders in patients who engage in an online cardiology consultation is lacking.

OBJECTIVE: This study aimed to explore the feasibility of using a self-rating scale to assess mental illness among patients who consult with a cardiologist online and to compare the differences in anxiety and depression between online and offline patients.

METHODS: From June 2022 to July 2022, we conducted follow-up visits with 10,173 patients on the Haodf platform. We conducted detailed consultations with 286 patients who visited the same cardiologist in the outpatient department. We used the self-rated Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) scales to assess anxiety and depression, respectively. We analyzed the influencing factors related to the degree of coordination of online patients. We also compared the prevalence of anxiety or depression between online and offline patients and analyzed the factors related to anxiety or depression.

RESULTS: Of the 10,173 online consultation patients, only 186 (1.8%) responded effectively. The response rate of the offline consultation patients was 96.5% (276/286). Frequent online communication and watching live video broadcasts were significantly related to effective responses from online patients (P<.001). The prevalence of anxiety (70/160, 43.7% vs 69/266, 25.8%; P<.001) or depression (78/160, 48.7% vs 74/266, 27.7%; P<.001) in online consultation patients was significantly higher than that in offline patients. In bivariate analyses, the factors related to anxiety included female sex, unemployment, no confirmed cardiovascular disease, and the online consultation mode, while smokers and those who underwent COVID-19 quarantine were less likely to present with anxiety. The factors related to depression included female sex, divorced or separated individuals, and the online consultation mode. COVID-19 quarantine was related with a lower likelihood of depression. BMI was negatively correlated with depression. In multiple ordered logistic regression analysis, women were more likely than men to present with anxiety (odds ratio [OR] 2.181, 95% CI 1.365-3.486; P=.001). Women (OR 1.664, 95% CI 1.082-2.559; P=.02) and online patients (OR 2.631, 95% CI 1.305-5.304; P=.007) were more likely to have depression.

CONCLUSIONS: Online patients had more anxiety or depression than offline patients. Anxiety was more prevalent in women, the unemployed, and those without confirmed cardiovascular disease. Women and divorced or separated individuals were more prone to depression. Increasing the frequency of doctor-patient communication and participating in video interactions can help improve patient cooperation.

PMID:37792455 | DOI:10.2196/48750

Epileptic Disord. 2023 Oct 4. doi: 10.1002/epd2.20165. Online ahead of print.

ABSTRACT

OBJECTIVE: In the presurgical evaluation of patients with drug-resistant epilepsy (DRE), occasionally, patients do not experience spontaneous typical seizures (STS) during a stereo-electroencephalography (SEEG) study, which limits its effectiveness. We sought to identify risk factors for patients who did not have STS during SEEG and to analyze the clinical outcomes for this particular set of patients.

METHODS: We conducted a retrospective analysis of all patients with DRE who underwent depth electrode implantation and SEEG recordings between January 2013 and December 2018.

RESULTS: SEEG was performed in 155 cases during this period. Eleven (7.2%) did not experience any clinical seizures (non-STS group), while 143 experienced at least one patient-typical seizure during admission (STS group). No significant differences were found between STS and non-STS groups in terms of patient demographics, lesional/non-lesional epilepsy ratio, pre-SEEG seizure frequency, number of ASMs used, electrographic seizures or postoperative seizure outcome in those who underwent resective surgery. Statistically significant differences were found in the average number of electrodes implanted (7.0 in the non-STS group vs. 10.2 in STS), days in Epilepsy Monitoring Unit (21.8 vs. 12.8 days) and the number of cases that underwent resective surgery following SEEG (27.3% vs 60.8%), respectively. The three non-STS patients (30%) who underwent surgery, all had their typical seizures triggered during ECS studies. Three cases were found to have psychogenic non-epileptic seizures. None of the patients in the non-STS group were offered neurostimulation devices. Five of the non-STS patients experienced transient seizure improvement following SEEG.

CONCLUSION: We were unable to identify any factors that predicted lack of seizures during SEEG recordings. Resective surgery was only offered in cases where ECS studies replicated patient-typical seizures. Larger data sets are required to be able to identify factors that predict which patients will fail to develop seizures during SEEG.

PMID:37792454 | DOI:10.1002/epd2.20165

JMIR Hum Factors. 2023 Oct 4;10:e48220. doi: 10.2196/48220.

ABSTRACT

BACKGROUND: Previous studies have identified that the effective management of cyber security in large health care environments is likely to be significantly impacted by human and social factors, as well as by technical controls. However, there have been limited attempts to confirm this by using measured and integrated studies to identify specific user motivations and behaviors that can be managed to achieve improved outcomes.

OBJECTIVE: This study aims to document and analyze survey and interview data from a diverse range of health care staff members, to determine the primary motivations and behaviors that influence their acceptance and application of cyber security messaging and controls. By identifying these issues, recommendations can be made to positively influence future cyber security governance in health care.

METHODS: An explanatory sequential mixed methods approach was undertaken to analyze quantitative data from a web-based staff survey (N=103), with a concurrent qualitative investigation applied to data gathered via in-depth staff interviews (N=9). Data from both stages of this methodology were mapped to descriptive variables based on a modified version of the Technology Acceptance Model (TAM; TAM2). After normalization, the quantitative data were verified and analyzed using descriptive statistics, distribution and linearity measures, and a bivariate correlation of the TAM variables to identify the Pearson coefficient (r) and significance (P) values. Finally, after confirming Cronbach α, the determinant score for multicollinearity, and the Kaiser-Meyer-Olkin measure, and applying the Bartlett test of sphericity (χ²), an exploratory factor analysis (EFA) was conducted to identify the primary factors with an eigenvalue (λ) >1.0. Comments captured during the qualitative interviews were coded using NVivo software (QSR International) to create an emic-to-etic understanding, which was subsequently integrated with the quantitative results to produce verified conclusions.

RESULTS: Using the explanatory sequential methodology, this study showed that the perceived usefulness of security controls emerged as the most significant factor influencing staff beliefs and behaviors. This variable represented 24% of all the variances measured in the EFA and was also the most common category identified across all coded interviews (281/692, 40.6%). The word frequency analysis showed that systems, patients, and people represented the top 3 recurring themes reported by the interviewees.

CONCLUSIONS: To improve cyber security governance in large health care environments, efforts should be focused on demonstrating how confidentiality, integrity, availability, policies, and cloud or vendor-based controls (the main contributors of usefulness measured by the EFA) can directly improve outcomes for systems, staff, and patients. Further consideration also needs to be given to how clinicians should share data and collaborate on patient care, with tools and processes provided to support and manage data sharing securely and to achieve a consistent baseline of secure and normalized behaviors.

PMID:37792450 | DOI:10.2196/48220

Clin Cancer Res. 2023 Oct 4. doi: 10.1158/1078-0432.CCR-23-1340. Online ahead of print.

ABSTRACT

Since the first approval of a tumor-agnostic indication in 2017, a total of seven tumor-agnostic indications involving six drugs have received approval from the US Food and Drug Administration. In this paper, the master protocol subteam of the Statistical Methods in Oncology Scientific Working Group, Biopharmaceutical Session, American Statistical Association, provides a comprehensive summary of these seven tumor-agnostic approvals, describing their mechanisms of action; biomarker prevalence; study design; companion diagnostics; regulatory aspects, including comparisons of global regulatory requirements; and Health Technology Assessment approval. Also discussed are practical considerations relating to the regulatory approval of tumor-agnostic indications, specifically: (1) recommendations for the design stage to mitigate the risk that exceptions may occur if a treatment is initially hypothesized to be effective for all tumor types; and (2) because drug development continues after approval of a tumor-agnostic indication, recommendations for further development of tumor-specific indications in frontline patients in the setting of a randomized confirmatory basket trial, acknowledging the challenges in this area. These recommendations and practical considerations may provide insights for the future development of drugs for tumor-agnostic indications.

PMID:37792436 | DOI:10.1158/1078-0432.CCR-23-1340

J Med Food. 2023 Oct 4. doi: 10.1089/jmf.2023.0056. Online ahead of print.

ABSTRACT

The aim of this work was to evaluate the effect of blackberry juice consumption during pregnancy on the length of the brain, as well as on the cell density of the dentate gyrus in Wistar rat pups. Pregnant rats were divided into three groups: control (C), fed with standard diet and water ad libitum; BJ1, which received blackberry juice containing polyphenols (7.8 mg/kg) and anthocyanins (1.9 mg/kg); and BJ2, receiving blackberry juice containing polyphenols (9.3 mg/kg) and anthocyanins (3.54 mg/kg). On postnatal day 0, pups per litter, body weight, and length were measured, and cells in the dentate gyrus of male pups were quantified. Maternal body weight and pups per litter were statistically equal across experimental groups during pregnancy. Pups in BJ1 and BJ2 groups showed an increase in body weight (20%) and length (5%) when comparing to controls. An increase in brain length was observed in BJ2 group (8%) as compared to the control. A significant increase in the number of cells/mm² was observed in the dentate gyrus of the offspring in BJ1 (21.8%) and BJ2 (23.7%) groups when compared to the control group. Given the above, blackberry juice may be considered a potential functional food during pregnancy, while further research on prenatal and postnatal development must be done.

PMID:37792428 | DOI:10.1089/jmf.2023.0056

Biotechnol Prog. 2023 Oct 4:e3393. doi: 10.1002/btpr.3393. Online ahead of print.

ABSTRACT

Coffee is a crop of significant socioeconomic importance, and the reuse of agri-food by-products and biowaste has great potential across several industries. Coffee wastewater (CWW) is a valuable resource containing essential nutrients that can be utilized by Candida sorboxylosa for single-cell protein (SCP) production. This utilization contributes to mitigating the negative impacts of agro-industrial waste. The optimization of culture conditions using the design of experiments (DoE) technique is crucial in understanding the environmental factors influencing metabolite production. In our study, the DoE technique was employed to analyze culture conditions, including room temperature, pH 8.4, agitation at 200 rpm, a headspace of 60% (v/v), and an inoculum of 0.75 DO_600nm over 28-h period. This approach resulted in a remarkable SCP yield of 64.4% and dry cell weight (DCW) of 2.26 g/L. It is noteworthy that there is no literature reporting SCP production under alkaline pH conditions in yeast. Interestingly, our work demonstrated that an alkaline pH of 8.4 significantly influenced SCP production by C. sorboxylosa. The DoE technique proved to be an efficient statistical tool for optimizing culture conditions, offering several advantages, such as: (i) conducting cultures at room temperature to minimize unnecessary energy consumption; (ii) reducing the incubation time from 46 to 28 h, thereby enhancing overall productivity; (iii) achieving 1.7-fold increase in SCP yield compared to previous basal production levels.

PMID:37792408 | DOI:10.1002/btpr.3393

Health Phys. 2023 Oct 4. doi: 10.1097/HP.0000000000001742. Online ahead of print.

ABSTRACT

Through the integration of experimental data and literature, this study examines whether complete elimination of contact shielding during CT examination is warranted, with a particular focus on potential impacts to children’s thyroid and pregnant women, as well as limitations associated with contact shielding. Methods: The thermoluminescent dosimeter (TLD) tablets were inserted into the phantom’s five organs and tissues. Select fixed exposure, automatic exposure control (AEC), and use contact shielding combined into four experimental modes, with scanning of the phantom’s four parts. Obtain the absorbed dose measurements within or outside the FOV. Statistical analysis was conducted using SPSS software. Results: (1) The AEC significantly reduces dose within and outside the FOV, with a dose reduction of 40%-60%. (2) The application of contact shielding outside the FOV significantly reduced the dose adjoin the FOV. (3) Both the use of AEC mode and contact shielding can effectively minimize the dose, with a reduction of 50-80%. (4) The shielding within the FOV may introduce image artifacts or interfere with AEC, the implementation of contact shielding outside FOV provides little reduction in radiation exposure risk through previous literature. (5) Contact shielding exhibits certain drawbacks in all aspects. Conclusion: The utilization of AEC mode in clinical CT should be widely adopted to minimize patient radiation exposure. In general, contact shielding both inside and outside the FOV should be avoided during exposure. However for children under 12 years old with thyroid gland examination, contact shielding could maximally reduce external radiation and may be appropriate. Pregnant women require careful evaluation when considering the use of contact shielding. Contact shielding should not be entirely abandoned.

PMID:37792391 | DOI:10.1097/HP.0000000000001742

JAMA Netw Open. 2023 Oct 2;6(10):e2336863. doi: 10.1001/jamanetworkopen.2023.36863.

ABSTRACT

IMPORTANCE: Respiratory syncytial virus (RSV) is a leading cause of pediatric hospitalizations.

OBJECTIVE: To describe the epidemiology and burden of RSV-associated hospitalizations among children and adolescents in Canadian tertiary pediatric hospitals from 2017 to 2022, including changes during the COVID-19 pandemic.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted during 5 RSV seasons (2017-2018 to 2021-2022) at 13 pediatric tertiary care centers from the Canadian Immunization Monitoring Program Active (IMPACT) program. Hospitalized children and adolescents aged 0 to 16 years with laboratory-confirmed RSV infection were included.

MAIN OUTCOMES AND MEASURES: The proportion of all-cause admissions associated with RSV and counts and proportions of RSV hospitalizations with intensive care unit (ICU) admission, prolonged stay (≥7 days), and in-hospital mortality were calculated overall and by season, age group, and region. Seasonality was described using epidemic curves. RSV hospitalizations for 2021-2022 were compared with those in the prepandemic period of 2017-2018 through 2019-2020. Bonferroni corrections were applied to P values to adjust for multiple statistical comparisons.

RESULTS: Among 11 014 RSV-associated hospitalizations in children and adolescents (6035 hospitalizations among male patients [54.8%]; 5488 hospitalizations among patients aged <6 months [49.8%]), 2594 hospitalizations (23.6%) had admission to the ICU, of which 1576 hospitalizations (60.8%) were among children aged less than 6 months. The median (IQR) hospital stay was 4 (2-6) days. The mean (SD) number of RSV-associated hospitalizations during prepandemic seasons was 2522 (88.8) hospitalizations. There were 58 hospitalizations reported in 2020-2021, followed by 3170 hospitalizations in 2021-2022. The proportion of all-cause hospitalizations associated with RSV increased from a mean of 3.2% (95% CI, 3.1%-3.3%) before the pandemic to 4.5% (95% CI, 4.3%-4.6%) in 2021-2022 (difference, 1.3 percentage points; 95% CI, 1.1-1.5 percentage points; corrected P < .001). A significant increase in RSV-associated hospitalizations was found in 2021-2022 for 3 provinces (difference range, 2.5 percentage points; 95% CI, 1.4-3.6 percentage points for Quebec to 2.9 percentage points; 95% CI, 1.4-3.5 percentage points for Alberta; all corrected P < .001). Age, sex, ICU admission, prolonged length of stay, and case fatality rate did not change in 2021-2022 compared with the prepandemic period. Interregional differences in RSV seasonality were accentuated in 2021-2022, with peaks for 1 province in October, 4 provinces in December, and 3 provinces in April, or May.

CONCLUSIONS AND RELEVANCE: This study found that the burden of RSV-associated hospitalizations in Canadian pediatric hospitals was substantial, particularly among infants aged less than 6 months, and RSV hospitalizations increased in 2021-2022 compared with the prepandemic period, while severity of illness remained similar. These findings suggest that RSV preventive strategies for infants aged less than 6 months would be associated with decreased RSV disease burden in children.

PMID:37792376 | DOI:10.1001/jamanetworkopen.2023.36863

JAMA Surg. 2023 Oct 4. doi: 10.1001/jamasurg.2023.4847. Online ahead of print.

ABSTRACT

IMPORTANCE: Posterior components separation (PCS) is a commonly used myofascial release technique in ventral hernia repairs. The contribution of each release with anterior and posterior fascial advancement has not yet been characterized in patients with ventral hernias.

OBJECTIVE: To quantitatively assess the changes in tension on the anterior and posterior fascial elements of the abdominal wall during PCS to inform surgeons regarding the technical contribution of each step with those changes, which may help to guide intraoperative decision-making.

DESIGN, SETTING, AND PARTICIPANTS: This case series enrolled patients from December 2, 2021, to August 2, 2022, and was conducted at the Cleveland Clinic Center for Abdominal Core Health. The participants included adult patients with European Hernia Society classification M1 to M5 ventral hernias undergoing abdominal wall reconstruction with PCS.

INTERVENTION: A proprietary, sterilizable tensiometer measured the force needed to bring the fascial edge of the abdominal wall to the midline after each step of a PCS (retrorectus dissection, division of the posterior lamella of the internal oblique aponeurosis, and transversus abdominis muscle release [TAR]).

MAIN OUTCOME: The primary study outcome was the percentage change in tension on the anterior and posterior fascia associated with each step of PCS with TAR.

RESULTS: The study included 100 patients (median [IQR] age, 60 [54-68] years; 52 [52%] male). The median (IQR) hernia width was 13.0 (10.0-15.2) cm. After complete PCS, the mean (SD) percentage changes in tension on the anterior and posterior fascia were -53.27% (0.53%) and -98.47% (0.08%), respectively. Of the total change in anterior fascial tension, retrorectus dissection was associated with a mean (SD) percentage change of -82.56% (0.68%), incision of the posterior lamella of the internal oblique with a change of -17.67% (0.41%), and TAR with no change. Of the total change in posterior fascial tension, retrorectus dissection was associated with a mean (SD) percentage change of -3.04% (2.42%), incision of the posterior lamella of the internal oblique with a change of -58.78% (0.39%), and TAR with a change of -38.17% (0.39%).

CONCLUSIONS AND RELEVANCE: In this case series, retrorectus dissection but not TAR was associated with reduced tension on the anterior fascia, suggesting that it should be performed if anterior fascial advancement is needed. Dividing the posterior lamella of the internal oblique aponeurosis and TAR was associated with reduced tension on the posterior fascia, suggesting that it should be performed for posterior fascial advancement.

PMID:37792324 | DOI:10.1001/jamasurg.2023.4847

Pediatr Pulmonol. 2023 Oct 4. doi: 10.1002/ppul.26714. Online ahead of print.

ABSTRACT

BACKGROUND: The American Thoracic Society Guidelines recommend vancomycin as first line option for treatment of methicillin-resistant Staphylococcus aureus. Two studies have described the pharmacokinetics (PK) of intermittent intravenous (IV) vancomycin in adult people with cystic fibrosis (PwCF). Currently, there have not been any studies describing the PK of continuous infusion vancomycin in PwCF. Our study aimed to describe the PK of continuous infusion vancomycin in adult PwCF.

METHODS: Included patients were adult PwCF, who were admitted to University of Utah Hospital between May 11, 2014 and August 31, 2020, and received continuous infusion vancomycin for the treatment of an pulmonary exacerbations. The primary outcome was to describe vancomycin clearance rate (CL_vanco ) and total daily dose (TDD). Secondary outcomes included rates of acute kidney injury (AKI), liver injury, and infusion-related reactions.

RESULTS: Twenty patients were included in this study. The mean CL_vanco was 5.08 L/h on Day 3 and 4.58 L/h on Day 7 (p = .04), and the TDD increased from 2444 mg on Day 3 to 2556 on Day 7, although not statistically significant (p = 0.26). Zero patients experienced an AKI, two patients experienced liver injury, and no patients experienced infusion-related reactions.

CONCLUSIONS: This study demonstrates that continuous infusion vancomycin PK, namely CL_vanco , is similar to previously reported CL_vanco for intermittent dosed IV vancomycin in adult PwCF. This study suggests that continuous infusion vancomycin is likely safe to use in adult PwCF.

PMID:37792309 | DOI:10.1002/ppul.26714