Category: Nevin Manimala

Phys Med Biol. 2023 Feb 3. doi: 10.1088/1361-6560/acb8fc. Online ahead of print.

ABSTRACT

OBJECTIVE: Organ deformation models have the potential to improve delivery and reduce toxicity of radiotherapy, but existing data-driven motion models are based on either patient-specific or population data. We propose to combine population and patient-specific data using a Bayesian framework. Our goal is to accurately predict individual motion patterns while using fewer scans than previous models.

APPROACH: We have derived and evaluated two Bayesian deformation models. The models were applied retrospectively to the rectal wall from a cohort of prostate cancer patients. These patients had repeat CT scans evenly acquired throughout radiotherapy. Each model was used to create coverage probability matrices (CPMs). The spatial correlations between these estimated CPMs and the ground truth, derived from independent scans of the same patient, were calculated.\ Main results: Spatial correlation with ground truth were significantly higher for the Bayesian deformation models than both patient-specific and population-derived models with 1, 2 or 3 patient-specific scans as input. Statistical motion simulations indicate that this result will also hold for more than 3 scans. \ Significance: The improvement over previous models means that fewer scans per patient are needed to achieve accurate deformation predictions. The models have applications in robust radiotherapy planning and evaluation, among others.

PMID:36735964 | DOI:10.1088/1361-6560/acb8fc

Int Nurs Rev. 2023 Feb 3. doi: 10.1111/inr.12821. Online ahead of print.

ABSTRACT

AIM: To determine the effect of male nursing students’ voluntary activities on their image in society.

BACKGROUND: The role of voluntary nursing services in enhancing the visibility of nursing in society can also contribute to enhancing the image of male nurses in society.

METHODS: This study employed a one-group, quasi-experimental pre-post analysis design. It was carried out between September 2020 and June 2021 in the pedestrian zone, which is one of the main streets of Bartın in Turkey. Using a convenience sampling approach, tradesmen aged 18 and over operating in commercial enterprises (n = 81) were asked to participate in the study. Information form and Nursing Image Scale were used to collect the research data. Results from the paired sample t test were utilized to analyse the study’s data using the intervention of ‘men nursing students’ voluntary activities’.

RESULTS: The total Nursing Image Scale score of the participants was statistically considerably greater after the intervention than the pre-intervention score. Based on the paired sample t test results, it was observed that the participants obtained higher scores after the intervention than before in the gender sub-dimension as well as all other sub-dimensions of the Nursing Image Scale, and these results were statistically significant.

CONCLUSION: According to the findings of the study, volunteering by male nursing students improved both the profession of nursing and the perception of men in nursing in society.

IMPLICATIONS FOR NURSING/HEALTH POLICY: This study suggested that male nursing students’ voluntary activities could be one of the strategies to overcome the nursing shortage due to its enhancing effect on the profession of nursing and the perception of men in nursing in society.

PMID:36735939 | DOI:10.1111/inr.12821

JMIR Mhealth Uhealth. 2023 Feb 2. doi: 10.2196/44316. Online ahead of print.

ABSTRACT

BACKGROUND: Musculoskeletal (MSK) conditions are the number one cause of disability worldwide. Digital care programs (DCPs) for MSK pain management have risen as alternative care delivery models to circumvent challenges in accessibility of conventional therapy. Despite the potential of DCPs to reduce inequities in accessing care, the outcomes of such interventions in rural and urban populations have yet to be studied.

OBJECTIVE: The aim of the present study was to assess the impact of urban and rural residencies on engagement and clinical outcomes after a multimodal DCP for MSK pain.

METHODS: The study consists of an ad hoc analysis of a decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were coded according to their zip codes to a specific rural-urban commuting area (RUCA) code, and grouped into rural and urban cohorts. Their engagement, as well as clinical outcome changes from baseline to program-end were assessed. Latent growth curve analysis was performed to estimate change trajectories adjusting for the following covariates: age, gender, body mass index, employment status and pain acuity. Outcomes included engagement, self-reported pain, Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment. A minimum clinically important difference (MCID) of 30% was considered for pain.

RESULTS: Patients from urban and rural residencies across all the U.S. participated in the program (N= 9992). A 73.8% completion rate was observed. Both groups reported high satisfaction scores and similar engagement with exercise sessions, with rural residents showing higher engagement with educational content (P<.001) and higher program completion rates (P=.02). All groups showed a significant improvement in all clinical outcomes without inter-group statistical significance, including pain, mental health and work productivity. The percentage of patients meeting the MCID was similar in both groups (urban: 67%, rural: 68.7%, P=.24).

CONCLUSIONS: This study advocates for the utility of a DCP in improving access to MSK care in urban and rural areas alike, showcasing its potential to promote health equity. High engagement, satisfaction and completion rates were noted in both groups, as well as significant improvements in clinical outcomes.

CLINICALTRIAL: ClinicalTrials.gov NCT04092946.

PMID:36735933 | DOI:10.2196/44316

Ann Am Thorac Soc. 2023 Feb 3. doi: 10.1513/AnnalsATS.202208-738OC. Online ahead of print.

ABSTRACT

RATIONALE: Clear definition of optimal positive airway pressure therapy usage in patients with obstructive sleep apnea is not possible due to scarce data on the relationship between usage hours and major clinical outcomes.

OBJECTIVE: To investigate the dose-response relationship between positive airway pressure usage and healthcare resource utilization, and determine the minimum device usage required for benefit.

METHODS: A linked data set combined de-identified payer-sourced administrative medical/pharmacy claims data from >100 US health plans and individual patient positive airway pressure usage data. Eligible adults (age ≥18 years) had a new obstructive sleep apnea diagnosis between June 2014 and April 2018. All received positive airway pressure therapy (AirSense™ 10; ResMed) with claims data for ≥1 year before, and 2 years after, device setup. Healthcare resource utilization was determined based on the number of all-cause hospitalizations and emergency room visits over 3, 12 and 24 months after positive airway pressure initiation.

RESULTS: Data from 179,188 patients showed a clear dose-response relationship between daily positive airway pressure usage and healthcare utilization. Minimum device usage required for benefit was 1-3 h/night. There was a statistically significant decrease in hospitalizations and ER visits at all time points (all p<0.0001) with increasing PAP usage. Each additional h/night of usage decreased hospitalizations/emergency room visits by 5-10%/5-7%.

CONCLUSIONS: These data provide compelling evidence for a dose-response relationship between positive airway pressure usage and healthcare utilization, with benefits seen even when usage is as low as 1-2 h/night.

PMID:36735928 | DOI:10.1513/AnnalsATS.202208-738OC

Epidemiology. 2023 Feb 6. doi: 10.1097/EDE.0000000000001600. Online ahead of print.

ABSTRACT

BACKGROUND: Opioid-related mortality is an important public health problem in the United States. Incidence estimates rely on death certificate data generated by health care providers and medical examiners. Opioid overdoses may be underreported when other causes of death appear plausible. We applied physician-elicited death certificate bias parameters to quantitative bias analyses assessing potential age-related differential misclassification in U.S. opioid-related mortality estimates.

METHODS: We obtained cause-of-death data (U.S., 2017) from the National Center for Health Statistics and calculated crude opioid-related outpatient death counts by age category (25-54, 55-64, 65+). We elicited beliefs from 10 primary care physicians on sensitivity of opioid-related death classification from death certificates. We summarized elicited sensitivity estimates, calculated plausible specificity values, and applied resulting parameters in a probabilistic bias analysis.

RESULTS: Physicians estimated wide sensitivity ranges for classification of opioid-related mortality by death certificates, with lower estimated sensitivities among older age groups. Probabilistic bias analyses adjusting for physician-estimated misclassification indicated 3.1 times more (95% uncertainty interval: 1.2 – 23.5) opioid-related deaths than the observed death count in the 65+ age group. All age groups had substantial increases in bias-adjusted death counts.

CONCLUSIONS: We developed and implemented a feasible method of eliciting physician expert opinion on bias parameters for sensitivity of a medical record-based death indicator and applied findings in quantitative bias analyses adjusting for differential misclassification. Our findings are consistent with the hypothesis that opioid-related mortality rates may be substantially underestimated, particularly among older adults, due to misclassification in cause-of-death data from death certificates.

PMID:36735892 | DOI:10.1097/EDE.0000000000001600

Acta Medica (Hradec Kralove). 2022;65(3):99-104. doi: 10.14712/18059694.2022.25.

ABSTRACT

OBJECTIVE: The aim of this study was to compare the visual assessment of tooth shade with the measurement using intraoral scanner (IOS) and spectrophotometer devices.

METHODOLOGY: The colour for a single unit implant supported crown was measured visually, using IOS, and spectrophotometer. The results of the digital methods were compared with the visual measurement.

RESULTS: A complete colour match with the visual measurement was in 42.9% of cases for IOS, and in 33.3% of cases for spectrophotometry. The match in the colour value, hue, and chroma were in 61.9%, 95.2%, and 66.7% of cases, respectively, for the IOS; and in 61.9%, 61.9%, and 66.7% of cases, respectively, for the spectrophotometry. The differences between the IOS and spectrophotometry were not statistically significant.

CONCLUSIONS: The most reliable method for tooth colour selection is the visual measurement by an experienced dentist. IOS and spectrophotometer can be used as an alternative method, however in both cases they should be verified using visual measurement.

PMID:36735887 | DOI:10.14712/18059694.2022.25

Acta Medica (Hradec Kralove). 2022;65(3):75-82. doi: 10.14712/18059694.2022.22.

ABSTRACT

INTRODUCTION: To date, there is not generally accepted and universal indicator of activity, and functional integrity of the small intestine in patients with coeliac disease. The aim of our study was to investigate whether serum concentrations of the non-essential amino acids citrulline and ornithine might have this function.

METHODS: We examined serum citrulline and ornithine concentrations in a subgroup of patients with proven coeliac disease and healthy controls (blood donors).

RESULTS: A total of 94 patients with coeliac disease (29 men, mean age 53 ± 18 years; 65 women, mean age 44 ± 14 years) and 35 healthy controls (blood donors) in whom coeliac disease was serologically excluded (10 men, mean age 51 ± 14 years; 25 women, mean age 46 ± 12 years) were included in the study. Significantly lower concentrations of serum ornithine were found in patients with coeliac disease (mean 65 ± 3 μmol/L; median 63 μmol/L, IQR 34 μmol/L, p < 0.001). No statistically nor clinically significant differences were found in the citrulline concentrations between the study and control group.

CONCLUSIONS: Serum ornithine (but not citrulline) may be useful for assessing the functional status of the small intestine in uncomplicated coeliac disease. Further studies involving more detailed analysis of dietary and metabolic changes in patients will be needed to reach definitive conclusions.

PMID:36735884 | DOI:10.14712/18059694.2022.22

J Biopharm Stat. 2023 Feb 3:1-11. doi: 10.1080/10543406.2023.2170399. Online ahead of print.

ABSTRACT

Response adaptive randomization has the potential to treat more participants in better treatments in a trial to benefit participants. We propose optimal response adaptive randomization designs for a two-stage study with binary response, having the smallest expected sample size or the fewest expected number of failures. Equal randomization is used in the first stage, and data from the first stage is used to determine the adaptive sample size ratio in the second stage. In the proposed optimal designs, the type I error rate and the statistical power are calculated from the asymptotic normal distributions. The new designs that minimize the expected number of failures have the advantage over the existing optimal randomized designs to substantially reduce the number of failures.

PMID:36735855 | DOI:10.1080/10543406.2023.2170399

JMIR Form Res. 2023 Jan 24. doi: 10.2196/36608. Online ahead of print.

ABSTRACT

BACKGROUND: Access to data is crucial for decision-making; this fact has become more evident during the pandemic. Data collected using mobile applications can positively influence diagnosis and treatment, the supply chain, and staffing resources of healthcare facilities. Developers and healthcare professionals have worked to create applications that can track a person’s COVID status. For example, these applications can monitor positive COVID test results and vaccination status. Regrettably, people may be concerned about sharing their data with government or private sector organizations developing applications. Understanding user perceptions is essential; without substantial user adoption and the use of mobile tracing apps, the benefits cannot be achieved.

OBJECTIVE: This study aims to assess the factors that positively and negatively affect the use of COVID-tracing apps by examining individuals’ perceptions about sharing data on mobile applications, such as testing regularity, infection, and immunization status.

METHODS: The hypothesized research model was tested using a cross-sectional survey instrument. The survey contained five reflective constructs and four control variables selected after reviewing the literature and interviewing healthcare professionals. A digital copy of the survey was created using Qualtrics. After receiving approval from Institutional Board Review (IRB). Data was collected from 367 participants through Amazon Mechanical Turk (MTurk). The inclusion criteria for participants to complete the anonymized survey included those of any gender who were 18 years and older. We then analyzed the theoretical model using structural equation modeling (SEM).

RESULTS: After analyzing the quality of responses, n=325 participants, 66.46% were male (n=216), and 33.53% were female (n=109). Of the participants in the final dataset, 72.61% were employed. The results of the structural equation modeling showed that perceived vulnerability (β = 0.688, p < .001), Self-efficacy (β = 0.292, p < .001), and an individual’s prior infection with COVID (β = 0.194, p < .05) have statistically significant positive impacts on the intention to use mobile tracing apps. Privacy concerns (β = -0.360, p < .001), risk aversion (β = -0.150, p < .1), and a family members prior infection with COVID (β = – 0.139, p < .05) have statistically significant negative influences on a person’s intention to use mobile tracing apps.

CONCLUSIONS: This study illustrates that various user perceptions affect whether individuals utilize COVID-tracing applications technology. By working collaboratively on legislation and the messaging provided to potential users before releasing an application, developers, healthcare professionals, and policymakers can improve the use of tracking apps. Healthcare professionals need to emphasize disease vulnerability to motivate people to utilize mobile tracing apps which can help reduce the spread of viruses and diseases. In addition, more work is needed at the policy-making level to protect the privacy of users which in return can increase user engagement.

PMID:36735838 | DOI:10.2196/36608

Plast Reconstr Surg. 2023 Feb 2. doi: 10.1097/PRS.0000000000010280. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate whether neurosensory recovery of the inferior alveolar nerve (IAN) is influenced by its location following sagittal split osteotomy (SSO) in patients undergoing large mandibular movements.

METHODS: This was a prospective, split-mouth study of skeletally mature patients undergoing BSSO. Patients were included as study subjects if they underwent BSSO for mandibular advancement > 10 mm and, following the splits, the IAN was freely entering the distal segment (IANDI) on one side and within the proximal segment (IANPR) on the other. Descriptive, bivariate, and Kaplan-Meier statistics were computed.

RESULTS: The study sample included 13 subjects (8 female, mean age 18.7 ± 1.8 years) undergoing 26 SSOs. Eleven subjects underwent bimaxillary surgery; 10 had simultaneous genioplasty. The mean mandibular movement was 12.2 ± 1.4 mm and was not significantly different between sides (p = 0.43). All subjects achieved FSR bilaterally within 1 year of surgery. There was no difference in the median times to FSR based upon the location of the IAN (IANDI = 105 days vs IANPR = 126 days, p = 0.57).

CONCLUSION: In SSO for mandibular advancement with movements > 10 mm, leaving the IAN within the proximal segment may not impact time to FSR.

PMID:36735814 | DOI:10.1097/PRS.0000000000010280