Category: Nevin Manimala

JMIR Public Health Surveill. 2024 Feb 21;10:e47130. doi: 10.2196/47130.

ABSTRACT

BACKGROUND: Opioids have traditionally been used to manage acute or terminal pain. However, their prolonged use has the potential for abuse, misuse, and addiction. South Korea introduced a new health care IT system named the Narcotics Information Management System (NIMS) with the objective of managing all aspects of opioid use, including manufacturing, distribution, sales, disposal, etc.

OBJECTIVE: This study aimed to assess the impact of NIMS on opioid use.

METHODS: We conducted an analysis using national claims data from 45,582 patients diagnosed with musculoskeletal and connective tissue disorders between 2016 and 2020. Our approach included using an interrupted time-series analysis and constructing segmented regression models. Within these models, we considered the primary intervention to be the implementation of NIMS, while we treated the COVID-19 outbreak as the secondary event. To comprehensively assess inappropriate opioid use, we examined 4 key indicators, as established in previous studies: (1) the proportion of patients on high-dose opioid treatment, (2) the proportion of patients receiving opioid prescriptions from multiple providers, (3) the overlap rate of opioid prescriptions per patient, and (4) the naloxone use rate among opioid users.

RESULTS: During the study period, there was a general trend of increasing opioid use. After the implementation of NIMS, significant increases were observed in the trend of the proportion of patients on high-dose opioid treatment (coefficient=0.0271; P=.01) and in the level of the proportion of patients receiving opioid prescriptions from multiple providers (coefficient=0.6252; P=.004). An abrupt decline was seen in the level of the naloxone use rate among opioid users (coefficient=-0.2968; P=.04). While these changes were statistically significant, their clinical significance appears to be minor. No significant changes were observed after both the implementation of NIMS and the COVID-19 outbreak.

CONCLUSIONS: This study suggests that, in its current form, the NIMS may not have brought significant improvements to the identified indicators of opioid overuse and misuse. Additionally, the COVID-19 outbreak exhibited no significant influence on opioid use patterns. The absence of real-time monitoring feature within the NIMS could be a key contributing factor. Further exploration and enhancements are needed to maximize the NIMS’ impact on curbing inappropriate opioid use.

PMID:38381481 | DOI:10.2196/47130

JMIR Med Educ. 2024 Feb 21;10:e48507. doi: 10.2196/48507.

ABSTRACT

BACKGROUND: Evidence-based practice (EBP) is an important aspect of the health care education curriculum. EBP involves following the 5 EBP steps: ask, assess, appraise, apply, and audit. These 5 steps reflect the suggested core competencies covered in teaching and learning programs to support future health care professionals applying EBP. When implementing EBP teaching, assessing outcomes by documenting the student’s performance and skills is relevant. This can be done using mobile devices.

OBJECTIVE: The aim of this study was to assess occupational therapy students’ EBP skills as reported in a mobile app.

METHODS: We applied a cross-sectional design. Descriptive statistics were used to present frequencies, percentages, means, and ranges of data regarding EBP skills found in the EBPsteps app. Associations between students’ ability to formulate the Population, Intervention, Comparison, and Outcome/Population, Interest, and Context (PICO/PICo) elements and identifying relevant research evidence were analyzed with the chi-square test.

RESULTS: Of 4 cohorts with 150 students, 119 (79.3%) students used the app and produced 240 critically appraised topics (CATs) in the app. The EBP steps “ask,” “assess,” and “appraise” were often correctly performed. The clinical question was formulated correctly in 53.3% (128/240) of the CATs, and students identified research evidence in 81.2% (195/240) of the CATs. Critical appraisal checklists were used in 81.2% (195/240) of the CATs, and most of these checklists were assessed as relevant for the type of research evidence identified (165/195, 84.6%). The least frequently correctly reported steps were “apply” and “audit.” In 39.6% (95/240) of the CATs, it was reported that research evidence was applied. Only 61% (58/95) of these CATs described how the research was applied to clinical practice. Evaluation of practice changes was reported in 38.8% (93/240) of the CATs. However, details about practice changes were lacking in all these CATs. A positive association was found between correctly reporting the “population” and “interventions/interest” elements of the PICO/PICo and identifying research evidence (P<.001).

CONCLUSIONS: We assessed the students’ EBP skills based on how they documented following the EBP steps in the EBPsteps app, and our results showed variations in how well the students mastered the steps. “Apply” and “audit” were the most difficult EBP steps for the students to perform, and this finding has implications and gives directions for further development of the app and educational instruction in EBP. The EBPsteps app is a new and relevant app for students to learn and practice EBP, and it can be used to assess students’ EBP skills objectively.

PMID:38381475 | DOI:10.2196/48507

J Feline Med Surg. 2024 Feb;26(2):1098612X231216350. doi: 10.1177/1098612X231216350.

ABSTRACT

OBJECTIVES: A comparative assessment of systolic blood pressure (BP) measurement agreement and precision in two commonly used non-invasive BP devices was carried out in conscious cats.

METHODS: Systolic BP measurements were obtained from 50 conscious cats as part of their clinical investigations. All measurements were taken by the same operator and were performed according to the American College of Veterinary Internal Medicine (ACVIM) consensus guidelines. The same cuff location and cuff size were used for paired measurements. The order of device use was randomised, and an arousal score was assigned during each procedure. Precision was assessed using standard deviation and coefficient of variance comparisons. Agreement was assessed using graphical and statistical comparisons of derived ‘delta mean’ and ‘mean of means’ data.

RESULTS: A total of 50 cats aged between 3 months and 15 years were enrolled (29 domestic shorthair, seven domestic longhair, three British Shorthair, two Ragdoll, two Sphynx, two Persian, one Siamese, one Burmese, one Russian Blue, one Maine Coon and one Oriental) with a body weight in the range of 1.2-6.2 kg. BP measurements were in the range of 95-179 mmHg. Oscillometric measurements were associated with lower arousal scores. The Doppler device demonstrated superior repeatability precision. Body weight, sex, cuff size, cuff location, arousal score and the order in which the devices were used had no significant effect on precision or agreement. Correlation between the two devices was 0.0837 and agreement was considered clinically acceptable (<10 mmHg) in 32/50 (64%) cats. Of the 18 cats with suboptimal agreement, the oscillometric mean BP was higher in 14 (78%) cats.

CONCLUSIONS AND RELEVANCE: Based on this study sample, suboptimal agreement between paired CAT+ Doppler and SunTech Vet20 oscillometric BP measurements in 36% of conscious cats suggests that these devices should not be used interchangeably. Compared with Doppler, oscillometric measurements were consistently higher, particularly at higher blood pressures. Further studies are required to assess which device has superior accuracy in conscious cats.

PMID:38381465 | DOI:10.1177/1098612X231216350

Clin Cancer Res. 2024 Feb 21. doi: 10.1158/1078-0432.CCR-23-3709. Online ahead of print.

ABSTRACT

BACKGROUND: Hodgkin lymphoma (HL) survivors experience neurocognitive impairment despite receiving no central nervous system-directed therapy, though little is known about underlying mechanisms.

METHODS: HL survivors (n=197) and age-, sex- and race/ethnicity-frequency-matched community controls (n=199) underwent standardized neurocognitive testing, and serum collection. Luminex multiplex or ELISA assays measured markers of inflammation and oxidative stress. Linear regression models compared biomarker concentrations between survivors and controls and with neurocognitive outcomes, adjusting for age, sex, race, body mass index, anti-inflammatory medication, and recent infections.

RESULTS: HL survivors (mean[SD] current age 36[8] years, 22[8] years post-diagnosis) demonstrated higher concentrations of interleukin-6 (IL-6), high-sensitivity c-reactive protein (hs-CRP), oxidized low-density lipoprotein, and glutathione peroxidase (GPx), compared to controls (p’s<0.001). Among survivors, higher concentrations of IL-6 were associated with worse visuomotor processing speed (p=0.046). hs-CRP ≥3 mg/L was associated with worse attention, processing speed, memory, and executive function (p’s<0.05). Higher concentrations of malondialdehyde were associated with worse focused attention and visual processing speed (p’s<0.05). Homocysteine was associated with worse short-term recall (p=0.008). None of these associations were statistically significant among controls. Among survivors, hs-CRP partially mediated associations between cardiovascular or endocrine conditions and visual processing speed, while IL-6 partially mediated associations between pulmonary conditions and visuomotor processing speed.

CONCLUSIONS: Neurocognitive function in long-term survivors of HL appears to be associated with inflammation and oxidative stress, both representing potential targets for future intervention trials.

PMID:38381440 | DOI:10.1158/1078-0432.CCR-23-3709

JAMA Surg. 2024 Feb 21. doi: 10.1001/jamasurg.2023.7985. Online ahead of print.

ABSTRACT

IMPORTANCE: Surgical site infections frequently occur after open abdominal surgery. Intraoperative wound irrigation as a preventive measure is a common practice worldwide, although evidence supporting this practice is lacking.

OBJECTIVE: To evaluate the preventive effect of intraoperative wound irrigation with polyhexanide solution.

DESIGN, SETTING, AND PARTICIPANTS: The Intraoperative Wound Irrigation to Prevent Surgical Site Infection After Laparotomy (IOWISI) trial was a multicenter, 3-armed, randomized clinical trial. Patients and outcome assessors were blinded to the intervention. The clinical trial was conducted in 12 university and general hospitals in Germany from September 2017 to December 2021 with 30-day follow-up. Adult patients undergoing laparotomy were eligible for inclusion. The main exclusion criteria were clean laparoscopic procedures and the inability to provide consent. Of 11 700 screened, 689 were included and 557 completed the trial; 689 were included in the intention-to-treat and safety analysis.

INTERVENTIONS: Randomization was performed online (3:3:1 allocation) to polyhexanide 0.04%, saline, or no irrigation (control) of the operative wound before closure.

MAIN OUTCOME AND MEASURES: The primary end point was surgical site infection within 30 postoperative days according to the US Centers for Disease Control and Prevention definition.

RESULTS: Among the 689 patients included, 402 were male and 287 were female. The median (range) age was 65.9 (18.5-94.9) years. Participants were randomized to either wound irrigation with polyhexanide (n = 292), saline (n = 295), or no irrigation (n = 102). The procedures were classified as clean contaminated in 92 cases (8%). The surgical site infection incidence was 11.8% overall (81 of 689), 10.6% in the polyhexanide arm (31 of 292), 12.5% in the saline arm (37 of 295), and 12.8% in the no irrigation arm (13 of 102). Irrigation with polyhexanide was not statistically superior to no irrigation or saline irrigation (hazard ratio [HR], 1.23; 95% CI, 0.64-2.36 vs HR, 1.19; 95% CI, 0.74-1.94; P = .47). The incidence of serious adverse events did not differ among the 3 groups.

CONCLUSIONS AND RELEVANCE: In this study, intraoperative wound irrigation with polyhexanide solution did not reduce surgical site infection incidence in clean-contaminated open abdominal surgical procedures compared to saline or no irrigation. More clinical trials are warranted to evaluate the potential benefit in contaminated and septic procedures, including the emergency setting.

TRIAL REGISTRATION: drks.de Identifier: DRKS00012251.

PMID:38381428 | DOI:10.1001/jamasurg.2023.7985

J Vis. 2024 Feb 1;24(2):5. doi: 10.1167/jov.24.2.5.

ABSTRACT

Our perception does not depend exclusively on the immediate sensory input. It is also influenced by our internal predictions derived from prior observations and the temporal regularities of the environment, which can result in choice history biases. However, it is unclear how this flexible use of prior information to predict the future influences perceptual decisions. Prior information may bias decisions independently of the current sensory input, or it may modulate the weight of current sensory input based on its consistency with the expectation. To address this question, we used a visual decision-making task and manipulated the transitional probabilities between successive noisy grating stimuli. Using a reverse correlation analysis, we evaluated the contribution of stimulus-independent decision bias and stimulus-dependent sensitivity modulations to choice history biases. We found that both effects coexist, whereby there was increased bias to respond in line with the predicted orientation alongside modulations in perceptual sensitivity to favor perceptual information consistent with the prediction, akin to selective attention. Furthermore, at the individual differences level, we investigated the relationship between autistic-like traits and the adaptation of choice history biases to the sequential statistics of the environment. Over two studies, we found no convincing evidence of reduced adaptation to sequential regularities in individuals with high autistic-like traits. In sum, we present robust evidence for both perceptual confirmation bias and decision bias supporting adaptation to sequential regularities in the environment.

PMID:38381426 | DOI:10.1167/jov.24.2.5

Ophthalmologie. 2024 Feb 21. doi: 10.1007/s00347-024-01988-9. Online ahead of print.

ABSTRACT

Retinal optical coherence tomography (OCT) biomarkers have the potential to serve as early, noninvasive, and cost-effective markers for identifying individuals at risk for cognitive impairments and neurodegenerative diseases. They may also aid in monitoring disease progression and evaluating the effectiveness of interventions targeting cognitive decline. The association between retinal OCT biomarkers and cognitive performance has been demonstrated in several studies, and their importance in cognitive assessment is increasingly being recognized. Machine learning (ML) is a branch of artificial intelligence (AI) with an exponential number of applications in the medical field, particularly its deep learning (DL) subset, which is widely used for the analysis of medical images. These techniques efficiently deal with novel biomarkers when their outcome for the applications of interest is unclear, e.g., for diagnosis, prognosis prediction, disease staging, or any other relevance to clinical practice. However, using AI-based tools for medical purposes must be approached with caution, despite the many efforts to address the black-box nature of such approaches, especially due to the general underperformance in datasets other than those used for their development. Retinal OCT biomarkers are promising as potential indicators for decline in cognitive function. The underlying mechanisms are currently being explored to gain deeper insights into this relationship linking retinal health and cognitive function. Insights from neurovascular coupling and retinal microvascular changes play an important role. Further research is needed to establish the validity and utility of retinal OCT biomarkers as early indicators of cognitive decline and neurodegenerative diseases in routine clinical practice. Retinal OCT biomarkers could then provide a new avenue for early detection, monitoring and intervention in cognitive impairment with the potential to improve patient care and outcomes.

PMID:38381373 | DOI:10.1007/s00347-024-01988-9

J Clin Monit Comput. 2024 Feb 21. doi: 10.1007/s10877-024-01133-6. Online ahead of print.

ABSTRACT

Perfusion Computed Tomography (PCT) is an alternative tool to assess cerebral hemodynamics during trauma. As acute traumatic subdural hematomas (ASH) is a severe primary injury associated with poor outcomes, the aim of this study was to evaluate the cerebral hemodynamics in this context. Five adult patients with moderate and severe traumatic brain injury (TBI) and ASH were included. All individuals were indicated for surgical evacuation. Before and after surgery, PCT was performed and cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were evaluated. These parameters were associated with the outcome at 6 months post-trauma with the extended Glasgow Outcome Scale (GOSE). Mean age of population was 46 years (SD: 8.1). Mean post-resuscitation Glasgow coma scale (GCS) was 10 (SD: 3.4). Mean preoperative midline brain shift was 10.1 mm (SD: 1.8). Preoperative CBF and MTT were 23.9 ml/100 g/min (SD: 6.1) and 7.3 s (1.3) respectively. After surgery, CBF increase to 30.7 ml/100 g/min (SD: 5.1), and MTT decrease to 5.8s (SD:1.0), however, both changes don’t achieve statistically significance (p = 0.06). Additionally, CBV increase after surgery, from 2.34 (SD: 0.67) to 2.63 ml/100 g (SD: 1.10), (p = 0.31). Spearman correlation test of postoperative and preoperative CBF ratio with outcome at 6 months was 0.94 (p = 0.054). One patient died with the highest preoperative MTT (9.97 s) and CBV (4.51 ml/100 g). CBF seems to increase after surgery, especially when evaluated together with the MTT values. It is suggested that the improvement in postoperative brain hemodynamics correlates to favorable outcome.

PMID:38381360 | DOI:10.1007/s10877-024-01133-6

Methods Mol Biol. 2024;2765:23-46. doi: 10.1007/978-1-0716-3678-7_2.

ABSTRACT

Circular RNAs (circRNAs) are types of RNA molecules that have been discovered relatively recently and have been found to be widely expressed in eukaryotic cells. Unlike canonical linear RNA molecules, circRNAs form a covalently closed continuous loop structure without a 5′ or 3′ end. They are generated by a process called back-splicing, in which a downstream splice donor site is joined to an upstream splice acceptor site. CircRNAs have been found to play important roles in various biological processes, including gene regulation, alternative splicing, and protein translation. They can act as sponges for microRNAs or RNA-binding proteins and can also encode peptides or proteins. Additionally, circRNAs have been implicated in several diseases, including cancer, neurological disorders, and cardiovascular diseases.This protocol provides all necessary steps to detect and analyze circRNAs in silico from RNA sequencing data using the circtools circRNA analytics software suite. The protocol starts from raw sequencing data with circRNA detection via back-splice events and includes statistical testing of circRNAs as well as primer design for follow-up wet lab experiments.

PMID:38381332 | DOI:10.1007/978-1-0716-3678-7_2

Genes Genomics. 2024 Feb 21. doi: 10.1007/s13258-024-01503-z. Online ahead of print.

ABSTRACT

BACKGROUND: High temperature stress is an important abiotic factor, which affects tuberization and ultimately causes heavy yield reduction in potato.

OBJECTIVES: Identification and characterization of genes associated with tuberization under high temperature stress is essential for future management through biotechnology.

METHODOLOGY: Two contrasting potato varieties Kufri Anand (profuse tuber-bearing) versus Kufri Frysona (very less/scanty tuber-bearing, control) were cultivated in aeroponics under high temperature stress, and transcriptomes were analyzed.

RESULTS: Potato cv. Kufri Anand was found superior over control (Kufri Frysona) for tuber yield and its component traits along with root morphology under aeroponics. Transcriptomes of tuber and leaf tissues were analyzed. Statistically significant (p < 0.05) differentially expressed genes (DEGs) were categorised into up-regulated (> 2 log₂ fold change, FC) and down-regulated (< -2 log2 FC) genes. DEGs were annotated by gene ontology and KEGG pathways. A few selected up-regulated genes of both tissues were identified, and phylogeny tree and motif analysis were analysed based on 36 peptide sequences representing 15 selected DEGs in this study. Further, gene expression markers were developed and validated by real time qPCR analysis for the identification of high temperature tolerant genotypes.

CONCLUSION: A few key genes associated in tuberization under high temperature conditions were heat shock proteins (e.g. 18.5 kDa class I heat shock protein), sugar metabolism (e.g. glucosyltransferase), transcription factor (e.g. WRKY), and phytohormones (e.g. auxin-induced beta-glucosidase). Our study provides an overview of key genes involved in tuberization under high temperature stress in potato cv. Kufri Anand under aeroponics.

PMID:38381322 | DOI:10.1007/s13258-024-01503-z